The first SIX volumes are now ready, others will follow at intervals 
of about once a mouth. 

I. Hearing, and How to Keep It, 

By CHAS. H. BURNETT, M.D., of Philadelphia, 

Consulting Aurist to the Pennsylvania Institution for the Deaf and Dumb, 

Aurist to the Presbyterian Hospital, etc. 

II. Long Life, and How to Reach It, 



By J. G. RICHARDSON, M.D., of Philadelphia, 
Professor of Hygiene in the University of Pennsylvania, etc. 



If 



IV 



The Summer and its Diseases, 

By JAMES C. WILSON, M.D.,of Philadelphia, 

Lecturer on Physical Diagnosis in Jefferson Medical College, etc. 

Eyesight, and How to Care for It, 

By GEORGE C. HARLAN, M.D., of Philadelphia, 

Surgeon to the Wills {Eye) Hospital. 

V. The Throat and the Voice, 

By J. SOLIS COHEN, M.D., of Philadelphia, 

Lecturer on Diseases of t fie Throat in Jefferson Medical College. 

VI. The Winter and its Dangers, 

By HAMILTON OSGOOD, M.D., of Boston, 

Editorial Staff Boston Medical and Surgical Journal. 

VII. The Mouth and the Teeth, 

By J. W. WHITE, M.D., D.D.S., of Philadelphia, 

Editor of the Dental Cosmos. 

VIII. Our Homes, 

By HENRY HARTSHORNE, M.D., of Philadelphia, 

Formerly Professor of Hygiene in the University of Pennsylvania. 

IX. The Skin in Health and Disease, 

By L. D. BULKLEY, M.D., of New York, 

Physician to the Skin Department of the Demilt Dispensary and of the 
-\ ezu } "ork Hospital. 

X. Brain Work and Overwork, 

By H. C. WOOD, Jr., M.D., of Philadelphia, 

Clinical Professor of Nervous Diseases in the University of Pennsylvania, etc. 

XI. Sea-Air and Sea-Bathing, 

By JOHN H. PACKARD, M.D., of Philadelphia, 

Surgeon to the Episcopal Hospital. 

Other volumes are in preparation, including the following subjects : M Preventable 
Jiseases," "Accidents and Emergencies," "Towns we Live In," "Diet in 
health and Disease," "The Art of Nursing," "School and Industrial Hygiene," 
lk et °' * ne >' uil1 be l6mo in size, neatly printed on tinted paper, and bound in 
^loth, 50 cents. Mailed free upon receipt of price. 

LINDSAY & BLAKISTON, Publishers, Phila. 



AMERICAN HEALTH PRIMERS. 



EDITED BY 



W. W. KEEN, M.D., 

Fellow of the College of Physicians of Philadelphia, 
and Surgeon to St. Mary's Hospital. 



■H2- 



-©* 



AMERICAN HEALTH PRIMERS. 



THE 



Throat and the Voice. 



BY 

J. SOUS COHEN, M.D., 

Lecturer on Diseases of the Throat and Chest in Jefferson Medical 

College, and on Physiology and Hygiene of Voice in the 

National School of Elocution and Oratory. 



$ 



— 





- 1879. &J 

- 

PHILADELPHIA: 

LINDSAY & BLAKISTON. 

1879. 



■f* 






Copyright. 
LINDSAY & BLAKISTON. 

1879. 



CONTENTS. 



PART I. 

THE THROAT. 

CHAPTER PAGE 

I. General Construction of the Throat . 9 
II. Care of the Throat 19 

III. Acute Sore Throats 30 

IV. Diphtheria 42 

V. Croup 49 

VI. Acute Laryngitis 53 

VII. Chronic Sore Throats 56 

VIII. Enlarged Tonsils 66 

IX. Chronic Laryngitis 68 

X. Foreign Bodies in the Throat and Wind- 
pipe 72 

XI. Morbid Growths in the Throat and Wind- 
pipe . . . \ . . . .74 

XII. Paralysis of the Throat . . . .75 

XIII. Spasm of the Throat yy 

XIV. Neuralgia of the Throat . . . .82 

XV. Naso-Pharyngeal Catarrh . . . .83 
1 * v 



VI 



CONTENTS. 



PART II. 



THE VOICE. 

CHAPTER 

I. The Voice 
II. Acoustics of Voice 

III. Varieties of Voice 

IV. The Vocal Organ 
V. Vocal Culture 

VI. Improper Use of the Voice 
VII. Vocal Gymnastics 
VIII. Defects of Voice. 
IX. Care of the Voice 



87 
89 

113 
116 
129 
134 
143 
147 
154 



PREFACE. 



THERE is no pretension, in the following 
pages, to teach either the art of practising 
medicine or the art of cultivating the voice. 
The aim of the writer has been to direct the 
attention of the general reader to some scientific 
facts concerning the throat and the voice, 
and to present for consideration some opinions 
and advice based upon an intelligent appreciation 
of those facts. 

Should the perusal of this little volume incite 
desire for fuller expositions than have been dis- 
played in the " Primer," ample material is ac- 
cessible in various treatises on Anatomy, Phys- 
iology, Physics, and Vocal Culture. Study from 
these sources will be the more profitable, the 
more it is supplemented by personal investiga- 
tion. 




Fig. I, — Diagrammatic Anatomical Sketch of the Throat 
and Adjoining Structures, in Vertical Section ; to Indi- 
cate the Course of the Air and Food Tracks. 



vui 



THE 



THROAT AND THE VOICE. 



PART I. 
THE THROAT. 



CHAPTER I. 

GENERAL CONSTRUCTION OF THE THROAT. 

THE throat is the common highway, so to speak, 
for the passage of air to the lungs and of food to 
the stomach. 

It is protected and enclosed by various muscular 
and bony structures, chiefly occupying the neck, 
along which, too, course the great blood-vessels that 
nourish the head and the brain, as well as the great 
nerve-trunks that pass from the brain to the lungs, 
heart, stomach and intestines, and other organs ; 
while the strong bones at the back of the neck en- 
close the most important, or most vital, part of the 
spinal cord. 

Thus the throat and neck, together, are very im- 
portant regions of the body. The neck is directly 

9 



10 THE THROAT AND THE VOICE. 

exposed to atmospheric changes of wind and moist- 
ure, which sometimes induce disease in the throat or 
in the lungs; and the interior of the throat is exposed, 
in addition, to the baneful influences of whatever del- 
eterious substances may happen to be floating in the 
atmosphere. 

Fig. I. (see Frontispiece) is a diagramatic, anatom- 
ical sketch, showing the double route taken by the air 
through the nose and the mouth to the air-tube, as des- 
ignated by the dotted lines, and the single route taken 
by the food through the mouth into the gullet behind 
the air-tube, indicated by the unbroken line. 

Keeping the relations of the food- and air-tracts in 
mind, let the reader look into the throat of an indi- 
vidual whose tongue is kept flat down on the floor of 
the mouth by a paper-cutter, spoon-handle, or some- 
thing of that kind. This will expose to view the in- 
terior of that portion of the throat (the middle por- 
tion of the pharynx) which is common to the two 
great avenues by which air and food are conveyed into 
the interior of the body. The avenue for air, or the 
respiratory tract, is a double one at top, air reaching 
the pharynx by the interior of the nose above, as in 
ordinary breathing, or by the mouth in front, as in 
occasional breathing. Passing through the pharynx, 
the air next passes through a rigid tube {larynx and 
trachea), the windpipe, open on top, — except at mo- 
ments of swallowing and during certain accidents, — 



■H 



GENERAL CONSTRUCTION OF THE THROAT. II 



and always distended by means of stiff plates and 
rings of gristle {cartilage), which surround it more or 
less completely. Thence, the air passes along the 
subdividing continuations of the air-tube or wind- 
pipe {primitive, diminutive, and terminative or ulti- 
mate bronchial tubes) until it reaches the air-cells 
of the lungs, which are grouped in series around 
each ultimate extremity of this series of air-passages. 
These successive divisions of the air-tube are, pro- 
gressively, smaller and smaller, the terminal ones be- 
ing about one-fortieth of an inch in diameter. 

The avenue for food, or the alimentary tract, passes 
through the mouth into the pharynx, which it fol- 
lows down directly into the gullet (food-pipe, oesoph- 
agus), continuous with the pharynx, and leading into 
the stomach. This gullet is located behind the upper 
part of the air-tube (larynx and trachea), and rests 
against the spinal column, or back-bone. The gul- 
let, however, is a flaccid tube, its anterior and poste- 
rior walls being in contact, except when separated 
by the entrance of morsels of food or swallows of 
liquid. 

Now, although air may enter the body by two 
avenues — nose and mouth, — it is to be remembered 
that respiration through the nose is the natural method. 
Consequently, whenever respiration takes place habit- 
ually through the mouth, that method of breathing 
is indicative of some obstruction in the nasal passages 



12 THE THROAT AND THE VOICE. 

or in the upper portion of the pharynx, temporary or 
permanent, as may be. 

If the reader will examine the image of his mouth 
and throat as reflected in a well-illuminated mirror, 
such as a hand-mirror, which he can move in such a 
manner as to throw the rays of light upon the various 
portions he is observing, he will notice a movable 
curtain, the soft palate, hanging from the back por- 
tion of the roof of the mouth, or hard palate. When 
a deep inspiration is taken through the mouth, it will 
be noticed that this soft palate is forced backward 
until it touches the back wall of the throat, the phar- 
ynx ; but when the inspiration is taken through the 
nose, it will be seen that the soft palate moves forward 
somewhat, so as to leave a considerable space between 
it and the pharynx, in order that the air can pass by 
that route into the larynx, and thence through the 
windpipe into the lungs. This soft palate is composed 
chiefly of muscles, covered by the general lining mem- 
brane (mucous membrane) of the mouth and throat. 
Its lower border is crescentic on each side, the cen- 
tral portion being prolonged into a tapering extremity, 
the uvula, which, when elongated, is apt to touch the 
base of the tongue or the valve {epiglottis) on top of 
the larynx, and thus produce a sense of tickling, or 
other annoyance, which gives frequent rise to " hem- 
ming" or to a slight cough to relieve the disagree- 
able sensation. The soft palate on each side of the 



GENERAL CONSTRUCTION OF THE THROAT 1 3 



uvula is seen to divide into two folds, the front and 
narrower one of which reaches downward to the side 
of the root of the tongue, while the back and broader 
one reaches farther down to the side of the throat or 
pharynx. Between each of these pair of folds, a small 
body, the to?isil, is seen to project slightly. Each 
tonsil is a mass of glands, very apt to become enlarged 
in acute and chronic sore throat. Acute inflamma- 
tion of the tonsil constitutes the prominent feature of 
the affection known as quinsy. The tonsils are apt to 
become permanently enlarged in scrofulous people, 
and then sometimes interfere so much with respiration 
as to require removal of a considerable portion of 
their bulk. They rarely enlarge for the first time 
after about the thirtieth year of age. Children with 
chronically enlarged tonsils are liable to a deformity 
of the chest, on account of the position they are 
compelled to assume in order to breathe with any 
degree of comfort. This likewise interferes with due 
expansion of the lungs, and proper aeration of the 
blood, and thus often leads to serious ill-health. It 
is therefore of the greatest importance to future well- 
being that diseased tonsils be properly treated, — the 
sooner the better. Confidence in the popular opin- 
ion that children " will grow out of it " will only end 
in prolonged suffering, to be finally terminated by the 
interference which should have been instituted long 
before. 



14 THE THROAT AND THE VOICE. 

The back portion of the throat is the posterior 
wall of the pharynx, and is continuous with the back 
wall of the gullet or food-pipe, the oesophagus. Like 
the palate, it is chiefly muscular in structure, and is 
covered by a continuation of the same lining or 
mucous membrane. It is loosely attached to the 
spinal column and can be moved upon it. In dis- 
eases of the bones of the spinal column in this loca- 
tion, and in diseases of the glands between the gullet 
and the spinal column, this posterior wall of the 
throat is apt to become pushed forward into the free 
space of the throat by an abscess, or collection of pus, 
which interferes with respiration and with swallow- 
ing. As this disease occurs most frequently in chil- 
dren, the condition is often confounded with croup. 

The pharynx continues upward along the spinal 
column behind the palate until it reaches the base 
of the skull, when it bends forward into a vaulted 
roof, which has much the shape of the crooked fore- 
finger, or the top of a buggy wagon or phaeton. It 
is often easy to pass the finger up behind the palate 
of an individual and feel this roof of the pharynx. 
Being quite near the nerves from the brain, diseases 
of this portion of the pharynx are apt to be attended 
with a peculiar form of headache located just behind 
the upper portion of the root of the nose. If the 
forefinger carried up behind the palate is directed 
forward, a sharp ridge will be felt in front at the 



GENERAL CONSTRUCTION OF THE THROAT 1 5 



middle line. This is the hindermost portion of the 
septum or partition of the nose. On each side of 
it is an opening, which is the posterior orifice or 
outlet of the nasal passage a To each side of these 
openings, on the side wall of the pharynx, is a small 
protuberance, in the centre of which is a depression 
which leads into a delicate tube reaching to the drum 
portion of the ear, being in fact the vent-hole of that 
drum. When the nose is blown during the exist- 
ence of a cold in the head, a crackling is heard in the 
ear, due to the driving of air through a collection of 
mucus which has accumulated at the mouth of this 
tube. Diseases of the back portion of the nose and 
of the sides of the pharynx are very apt to be con- 
tinued into the ears in this way; and that is the rea- 
son why so many diseases of the ear follow the sore 
throat of scarlet-fever, chronic sore throat, chronic 
catarrh of the nasal passages, and so on. Some of 
the muscles of the palate cover a portion of the 
walls of the orifice of this tube, and this accounts 
for pain in the ears felt in many diseases of the 
throat, especially during the act of swallowing, which 
draws on the orifice of the tube to open it and let 
air penetrate into the drum of the ear. 

If the tongue is pulled forcibly forward, a little 
curved projection is sometimes seen behind it, at its 
deepest portion. This, the epiglottis, is a valve of 
gristle, by which the air-passage is covered over, dur- 



1 6 THE THROAT AND THE VOICE. 

ing the movement of swallowing, to prevent the food 
or drink from going the wrong way, i. e. into the 
larynx instead of the gullet. [See Larynx and Epi- 
glottis y article Voice .] It participates with the move- 
ments of the tongue, to the root of which it is at- 
tached by a strong ligament. It is also attached by 
ligaments to the sides of the throat ; and when these 
ligaments are very tense, their edges present to the 
fingei the sensation of a thin and firm foreign body, 
such as a pin or fish-bone, and are even liable to be 
mistaken for the intruder in cases in which such for- 
eign bodies have been swallowed, and be thus ruth- 
lessly pulled upon by those who are not aware of this 
circumstance. 

The larynx, which is guarded by this trap-door-like 
epiglottis, and which will be described in the article 
on Voice, to which it more appropriately belongs in 
this volume, is the vestibule or entrance into the wind- 
pipe {trachea). The windpipe is a hemispherical or 
tunnel-shaped tube running down the front part of 
the neck, dipping behind the breastbone into the 
chest, where it divides and subdivides into the bron- 
chial tubes. As respiration must be continuous, it is 
essential that this tube should always be open ; and it 
is therefore strengthened by a series of hoops of car- 
tilage in its front or hemispherical portion, while its 
posterior or flat portion is membranous and flexible, 
so as to yield to the pressure of articles of food or 



GENERAL CONSTRUCTION OF THE THROAT. \J 




i. Cartilage of the windpipe. 2. Mem- 
branous posterior wall of the wind- 
pipe. 3. Free space or cavity of the 
windpipe. 



drink which pass down the gullet or food-pipe, which 
is just behind it. Most popular accounts of this tube 
convey an impression Fig. II.— Diagram of a Trans- 
that it is circular rather verse Section through the Main 
than more or less he mi- Windpipe, or Trachea, of a Male 
spherical, as here de- Subject, 
scribed and figured. 
The membranous por- 
tion is smaller in the 
female than in the 
male. 

All the structures of 
the throat are lined, or 
covered, rather, with mucous membrane containing 
numerous little glands which secrete a bland 3 lubrica- 
ting fluid which keeps the parts moist, pliable, and 
comfortable. When this fluid is deficient, the parts 
become dry and uncomfortable ; and when it is in 
excess, it becomes mingled with little cast-off scales, 
similar to those cast off by the skin, as observed id 
the water after a bath, forming thick, tenacious masses 
of mucus, which irritate the parts and give rise to 
cough to get rid of them. The mucous membrane 
of the nasal passages and of the windpipe is provided 
with minute brush or hair-like processes, visible only 
under the microscope, which are continually waving 
towards the exterior of the body, and thus assist in 
brushing out any excess of mucus or particles of dust 
2* B 



1 8 THE THROAT AND THE VOICE. 

which have been inhaled into the nose or windpipe. 
In certain affections, these little hair-like appendages 
{cilia) are destroyed, without being reproduced, as 
they are in the healthy state ; and then there is some 
difficulty in getting rid naturally of the products 
alluded to in the last sentence, giving rise to more or 
less painful voluntary efforts of hawking, hemming, 
and coughing to eject them. Besides this, the delicate 
mucous membrane is exposed to the irritation of the 
air, and thus becomes further and further diseased, 
sometimes leading to the formation of real sores or 
ulcers. It is quite likely that many severe sore throats 
would be prevented, if the little annoyances which 
the loss of the cilia occasion were promptly remedied 
by application to the physician instead of the more 
frequent resort to the various cough mixtures, expec- 
torants, and lozenges exposed for sale. Many of these 
preparations are absolutely injurious, while there is 
only one chance out of very many that the article 
resorted to will happen to suit the individual case to 
which it is applied, even when the remedy is a good 
one. 



CHAPTER II. 



CARE OF THE THROAT. 



THERE are few individuals who pass their lives 
without having been at some time affected with 
more or less sore throat. In variable climates sore 
throat is much more frequent than in equable climates. 
It is much more frequent, also, in localities where 
individuals are exposed to the irritating influences of 
particles of dust and other materials in the atmos- 
phere, and which are inhaled in respiration. Conse- 
quently, people working in factories, chemical labora- 
tories, and the like, are quite subject to sore throat 
independently of any special proclivity thereto; while 
they are still more likely to suffer if constitutionally 
subject to sore throat. Such individuals are rec- 
ommended to wear little respirators in front of the 
nose and the mouth during exposure, in order to 
filter the respired air, as it were, and catch these little 
particles in their passage towards the throat. There 
is a variety of respirators for use, under these circum- 
stances, some of which are so arranged as to contain 
masses of raw cotton or wool, which collect the dust 

19 



20 



THE THROAT AND THE VOICE. 



and dirt, and which can be removed from time to 
time as they become foul. One of these, represented in 

Fig. III., is composed 
of meshes of delicate 
silvered wire, covered 
in front with a piece 
of silk. Pliny men- 
tions that workers in 
mines were accustomed 
to fasten bladders be- 
fore their mouths; and 
that the Roman bakers 
placed cloths in front 
of their faces when 
working in atmospheres 

loaded with dust. 
Fig. III. — Oro-nasal Respirator. T , . r . r i 

It is often found, too, 

that individuals suffering from consumption, chronic 
bronchitis, or even only with undue delicacy of the mu- 
cous membrane of the throat, are unable to face the air 
in windy and inclement weather. Sometimes they are 
unable to withstand the changes of temperature even 
on days which promise to be pleasant. Under such 
circumstances, they are compelled to keep in the house, 
or to muffle the mouth and nose with a handkerchief, 
veil, or something of that kind when they go out into 
the open air. The temperature of the inspired air 
is modified by the warmth imparted to the comforter 




CARE OF THE THROAT. 



21 



by the hotter air of respiration, while, at the same 
time, its pungency is moderated, if too rich in oxygen 
for the sensitive throat or air-passages. Unmitigated 
sunlight is known to be often irritating to sore eyes ; 
and in like manner unmitigated atmospheric air is 
sometimes too irritant to sore throats, sore air-passages, 
and sore lungs. In Great Britain, a respirator of a 
series of fine metallic meshes, covered with silk, is 
much used, and, if duly appreciated, would be much 
used in this country also. Some respirators are 
made merely to cover the 
mouth, so as to encourage 
nasal or normal respira- 
tion; and others (Fig. III., 
pi 20) to cover both mouth 
and nose. These appliances 
are rather unsightly, to be 
sure, but their use often en- 
ables invalids to take regular 
out-door exercise, in car- 
riage or on foot, instead of 
undergoing compulsory con- 
finement to the house for 
fear of catching cold. Ladies 
may make use of a respira- 
tory veil (Fig. IV.), devised 
by Mr. Lenox Browne, of London. It consists of 
a piece of plain, unspotted blonde, with a double 




Fig. IV. 
The Respiratory Veil. 



22 THE THROAT AND THE VOICE. 

thickness of silk gossamer on the lower four inches. 
The part that covers the mouth and nostrils is stiff- 
ened by a layer of thin wire gauze, so that the 
veil may stand a little away from the mouth and be 
more comfortable. Such a veil is easily made at 
home. 

There is a special proclivity to sore throat in many 
persons. This is often hereditary. People so disposed 
require more precaution than others in exposing them- 
selves to the changes of the atmosphere, and to other 
causes which are likely to excite sore throat. 

The most frequent exciting cause of diseases of the 
throat appears to be the direct action of cold upon 
the heated body, especially during active perspiration. 
Sudden exposure to .heat when the body has been 
chilled, is likewise a frequent cause of sore throat. 
It is therefore necessary to avoid these sudden expo- 
sures. In cold weather, for instance, when the tem- 
perature in-doors is much higher than it is out of 
doors, one should not go into the open air directly 
from a warm room, or go at once into a very warm 
room, and still less, close to a fire, on coming into the 
house from the street. A few minutes should be passed 
in the entry, in either instance, so as to render the 
change more gradual. In similar manner, a cool bath 
should not be taken while the body is in active per- 
spiration, lest it check the natural transudation of 
fluids and throw them in, as it is termed, upon the 



CARE OF THE THROAT. 



23 



internal organs, to their detriment. Taking a child 
from a warm bed to the window to see a parade, etc., 
is a not infrequent cause of the severest kind of sore 
throat. 

Another frequent source of sore throat, to which 
males are subjected much more than females, is 
breathing in an atmosphere laden with tobacco 
smoke, as in the sitting-rooms of public houses, cer- 
tain concert-saloons, and the like. This is a much 
more frequent source of danger than smoking tobacco 
in a private apartment, although that, too, is some- 
times a cause of sore throat. If a smoker is subject 
to attacks of sore throat, and is too wedded to his 
weed to divorce himself from it, he should smoke a 
long-stemmed pipe in preference to any other con- 
trivance, because it renders the smoke cooler by the 
time it reaches the throat. The next safest thing to 
smoke is a long cigar, not much more than half of 
which should be used, because the remainder becomes 
warmer and more loaded with the poisonous products 
of the combustion. A short pipe is not as safe as a 
cigar, and a cigarette is the most injurious of all. 
The habits of inhaling the tobacco smoke, of swal- 
lowing it, or of passing it out by the nose, are all 
likely to lead to disease of the parts over which the 
smoke is forced. Indeed, there is a peculiar condi- 
tion of the throat produced by tobacco smoking, 
which almost any slave to the practice can observe in 



24 THE THROAT AND THE VOICE. 

himself. It consists in a series of opalescent or 
milky-looking patches at the inside of the corners of 
the mouth and lips, and some other localities, due to 
a sort of raising of the outermost layer of the mucous 
membrane. These spots are known as the milky 
patches of smokers, and are sometimes mistaken for 
evidence of a very unfortunate constitutional form of 
sore throat. They subside, usually, on abandoning 
the practice. 

Another source of sore throat, very common in 
the United States, is the use of ice-water at meals. 
Many persons take their coffee, tea, soups, meats, and 
vegetables very hot, and cool the parts — mouth and 
throat — by draughts of ice-water immediately after- 
ward. This frequent alternation of extreme heat 
and cold eventually injures the delicate structures 
subjected to it. Even when ice-water is used at 
proper times, it is best to take it by sips, which should 
be allowed to remain a few moments in the mouth until 
the extreme chill has passed off, than to pour it down 
the throat in a series of continuous swallows. 

Another source of sore throat exists in overstraining 
the muscles in loud talking, protracted reading aloud 
and singing, screaming, calling to the deaf, and so on. 
In public speakers and singers, sore throat is often 
due to improper methods of breathing and of using 
the voice, and is only to be corrected by judicious 
elocutionary exercise, or a system of vocal gymnas- 



CARE OF THE THROAT. 



25 



tics. Theatrical performers, on the other hand, who 
pay much greater attention to a proper use of their 
vocal organs, rarely suffer from this cause, although 
they are subject to sore throat from ill-ventilated 
dressing-rooms, exposed and illy heated stage-flies, 
and the like. 

Finally, the inordinate use of alcoholic liquors is 
another source of sore throat. 

Individuals predisposed to contract sore throat, or 
specially liable to exposure to the causes that pro- 
duce it, should get into the habit of bathing the sur- 
face of the body every morning on leaving the bed. 
Those who prefer the regular bath by immersion may 
resort to that. Some prefer the shower-bath. When 
the full bath is inconvenient, the body should be 
mopped with a wet sponge or towel, the temperature 
of the water being as cool as is consistent with a 
feeling of comfort. If the practice is begun during 
warm weather, with the ordinary water in the wash- 
basin, it can be continued on into the winter, and 
throughout the winter, too, for that matter, by most 
persons, without any necessity for heating the water as 
the weather becomes colder. If the practice is com- 
menced during the cold weather, the water may be 
used warm at first, and gradually be used less and less 
warm as the individual becomes accustomed to it. If 
the cold bath or cold bathing chills the surface at any 
period of the year, summer or winter, or does not 
3 



26 THE THROAT AND THE VOICE. 

produce an agreeable glowing sensation after it, the 
water used may be impregnated with a little table salt, 
pickling salt, or sea salt, in the proportion of a hand- 
ful to a bucket of water. A bag of salt may be im- 
mersed in the water a short time before it is used. 
Where even this plan fails in its purpose, a cloth or 
sponge dipped in warm water, warm salt water, or warm 
acidulated water, (say a teaspoonful of aromatic sul- 
phuric acid or a teaspoonful or two of vinegar to the 
ordinary basinful,) may be applied to small portions of 
the body exposed in succession, until the system be- 
comes educated, as it were, to endure simple water at 
ordinary temperatures. There is no necessity for the 
use of a flesh- brush or rough towel after these ablutions, 
though there is no objection to be made to their use 
when their effects are agreeable. These baths are 
excellent tonics to the skin, and, through the influence 
of the nerves ramifying in it, to the system at large. 
They induce increased tolerance to ordinary atmos- 
pheric changes, and often inure the constitution to- 
resist injurious influences which might otherwise be 
sustained by forced or unexpected exposure to ex- 
traordinary changes. 

A person subject to diseases of the throat should 
be exceedingly careful as regards the use of under- 
clothing. The undershirt and drawers should be of 
flannel, or of some mixed fabric containing wool, such 
as the ordinary merino garments of the shops. Those 



CARE OF THE THROAT. 



27 



who can afford it may use silk. Silk and wool, being 
animal fabrics, are much more suitable for covering 
the human animal than vegetable fabrics, such as cot- 
ton and linen. Buckskin and chamois, though animal 
fabrics, are not suitable for underclothing, no matter 
how well "perforated " they may be to provide better 
ventilation. They are very soon rendered very filthy 
garments, even on the cleanliest bodies, because they 
retain accumulated products of cutaneous secretion, 
which undergo decomposition, and are often produc- 
tive of great injury. An undergarment should be of 
ioose texture, and capable of being easily washed or 
made clean. 

To suit the varying seasons of a climate such as 
ours, three varieties of weight of underclothing should 
be used, — one, the lightest texture made, for the ex- 
treme heat of summer; one of medium texture, for 
late spring and the autumn, and one much heavier, 
for winter and early spring. Changes from heavy 
fabrics to lighter ones should not be made until there 
is positive evidence of confirmed change of season. 
Some individuals wear underclothing of very light 
texture altogether, and use one, two, or more of 
them, as may be required, in preference to having 
garments of varying texture. The plan is a good 
one, especially for those who are apt to make too 
premature changes. It is very serviceable, too, when 
a change is made from heavy outer garments to 



28 THE THROAT AND THE VOICE. 

light ones, as in dressing for an evening entertain- 
ment, when the lessened weight in the dress-clothing 
may be supplemented by an additional light under- 
shirt and a pair of drawers. The underclothing worn 
in the daytime should be removed on going to bed, 
and be turned inside out to air and become well dried 
and ventilated by morning. It is very imprudent to 
sleep in the same underclothing which has been worn 
all day, or to wear during the day the underclothing 
used at night. It is rarely necessary to keep under- 
clothing on in bed, as there is little or no exposure 
to direct atmospheric change ; but where the protec- 
tion of a cotton night-gown is insufficient, a flannel 
night-gown may be used, or a special set of under- 
clothing. 

In the matter of stockings, there is not so much 
necessity for the use of wool in preference to cotton, 
even in winter. 

Boots and shoes are very important articles of 
clothing with regard to the health of individuals sub- 
ject to sore throat. Two pairs should always be in 
use at the same period, to be worn on alternate days 
respectively, inasmuch as a single night's exposure to 
the air is usually insufficient to free them from moist- 
ure ; and the practice of having two pairs in wear at 
a time will be found productive of an economy of 
about thirty-three per cent., a matter of some moment 
to many people in hard times. An additional pair, 



CARE OF THE THROAT. 



2 9 



exceptionally well-soled, should be kept for use in 
inclement weather. What are called double-sc^ed 
shoes or boots should be worn in winter, and in wet 
weather at any season ; and quite light soles are per- 
fectly safe in hot and dry weather. 

Water-proof shoes, rubbers, furs, and mufflers of 
all sorts, are not to be recommended for customary 
use. Rubbers and light water-proof cloaks are advis- 
able on occasions of special exposure, but should be 
removed as soon as the special occasion has passed. 
Water-proof garments should have slits under the arm- 
pits, and af other protected points, to favor ventila- 
tion. 

Confirmed invalids who cough on exposure to the 
outer air, should be careful not to talk during open- 
air exercise, and should wear a folded veil or a respi- 
rator in front of both nose and mouth when exposed 
to the wind, in order to modify the irritating influence 
of cold air upon the delicate mucous membrane of 
the throat. It is the confirmed opinion of the author, 
that if invalids suffering from diseases of the respira- 
tory organs would make systematic use of respirators, 
they would be spared a great deal of suffering, and 
would actually prolong their lives by the practice. 
3* 



CHAPTER III. 

ACUTE SOKE THROATS. 

THE term acute sore throat is used to designate an 
inflammatory condition, of comparatively short 
duration, affecting any portion or portions of the 
structures of the threat. Physicians apply separate 
names to inflammations confined to certain regions, 
but it is not requisite in this volume to allude to them 
individually. The chief general causes of acute sore 
throat are those already enumerated (pp. 22 and 23). 
There is another cause which must be borne in mind, 
which occurs chiefly in the dwellings of the poor, who 
are compelled to allow their children to play about 
the kitchen, and are unable to watch them carefully. 
The little ones try to get a drink of water for them- 
selves from the spout of the kettle of hot water, and 
thus inflict severe and often irreparable injury upon 
their throats and their upper air-passages. In many 
instances, death is inevitable after an accident of this 
kind. Care must be taken, therefore, that the kettle 
of hot water, coffee, or whatever it may be, shall be 
kept out of the reach of children. A similar acci- 

30 



ACUTE SORE THROATS. 



3* 



dent sometimes occurs with grown folks who are not 
careful about looking at their medicine bottles, and 
thus swallow a caustic liniment instead of a medicinal 
mixture, or administer the same to others. It is a 
good plan to insist upon it, that the apothecary should 
put all poisons, liniments, and the like in roughened 
bottles, — a special kind of which is made for the pur- 
pose, — so that the sensation imparted to the hand, 
even in the dark, will indicate caution, and thus pre- 
vent the liability of making such a dreadful mistake. 

Scalds of the kind alluded to are apt to be very 
severe. The cough and spasm produced by the act 
of swallowing these hot and acrid drinks involuntarily 
spatters them about the top of the larynx, the upper 
part of the throat, and even into the nasal passages. 
Much of the mucous membrane of these parts is killed 
at once, and there is violent inflammation, with great 
swelling, sometimes to such an extent as to choke the 
patient to death, unless the windpipe is opened sur- 
gically to allow access of air to the lungs from an arti- 
ficial aperture. Whenever such an accident occurs, 
whether in daytime or at night, the nearest reliable 
physician shouW be sent for at once, and the mind be 
prepared to learn that recovery is doubtful ; and that, 
even if it take place, a great deal of deformity may 
result, interfering, perhaps permanently, with freedom 
of swallowing and freedom of breathing. 

Ordinary sore throats, such as follow exposure to 



32 THE THROAT AND THE VOICE. 

cold, usually implicate the soft palate, uvula, and ton- 
sils, and even the base of the tongue. Sometimes 
the back part of the throat (the pharynx) is involved, 
but not often. In some instances the upper portions 
of the air-passages (larynx and trachea or windpipe) 
are also affected, and in others the nasal passages 
likewise. The same sort of sore throats is likewise 
due, in some instances, to the peculiar influence of 
certain medicines which are being used in the treat- 
ment of other diseases. These medicines are chiefly 
preparations of mercury, iodine, antimony, zinc, bella- 
donna, and stramonium. Whenever, therefore, a sore 
throat occurs, during treatment for another disease, 
and there is no ostensible reason to account for it, 
it is well to have the inquiry made as to whether it 
might not be the result of the action or overaction, 
or poisonous action of remedies in use at the time. 
Sometimes, too, these sore throats are occasioned by 
what is known in medical parlance as " reflex ac- 
tion ; ' ' that is to say, that an irritation of the nerves 
from a disease in the heart, liver, intestines, or some 
other organ, may be propagated along the spinal cord, 
which consists of the combined bundles of the nerve 
filaments that extend from it to all parts of the body, 
and then proceed from the spinal cord along the nerve 
fibres that leave it at another point to extend to the 
lining or mucous membrane of the throat. 

Sore throat, again, occurs from an extension of 



ACUTE SORE THROATS. 



33 



various diseases in the mouth, tongue, nose, and 
windpipe. It also occurs as a part of the ordinary 
manifestations of scarlet-fever, and likewise, but to 
a less extent, of small-pox and of measles. It also 
occurs in connection with a number of acute mala- 
dies, such as erysipelas, typhoid fever, rheumatism, 
influenza, and certain diseases of the skin. It like- 
wise occurs in a number of chronic diseases. The 
reason why the throat is affected in many of these 
affections has not yet been satisfactorily determined. 

Common Sore Throat. — This is a slight superficial 
inflammation of the covering or mucous membrane 
of both surfaces of the palate and uvula, and usually 
of the mucous or covering membrane of the tonsils 
also, extending, in some cases, to the same covering 
of the back part of the throat (the pharynx) ; but the 
mucous membrane of the mouth remains free. It is 
most frequent in children and quite young adults. 

The parts affected are red in color, more or less 
swollen, and secrete an excess of mucus. They are 
often quite painful on swallowing. Speech is often 
indistinct, but there is no hoarseness. There is no 
cough unless the uvula is elongated and tickles the 
back part of the tongue or the valve (epiglottis) on 
top of the air-passage. 

Sometimes a sore throat of this kind following 
exposure to wet, is very severe for a day or two, and 
subsides suddenly to give way to an attack of acute 

C 



34 THE THROAT AND THE VOICE. 

rheumatism. This form is known as rheumatic sore 
throat, and probably involves the muscles, or the 
sheaths of tissue in which the fibres of the muscles 
are enclosed, rather than being confined to the mu- 
cous membrane. 

In severe cases there is considerable fever, and this 
is severer in children than in adults. In severe cases, 
too, the glands at the angles of the jaw become 
swollen. 

It often happens that the sore throat is limited to 
one side of the body, and then the other side is apt 
to become affected, as the diseased action subsides in 
the first locality ; and if the individual be impru- 
dently exposed, the second attack is apt to be more 
intense than the first one. 

Unless there is some grave constitutional disorder, 
this form of sore throat gets well spontaneously in 
from five to ten days, according to its severity. 

Very often, cases of slight sore throat require no 
special medical treatment whatever. It is prudent, 
however, to keep in the house, lying upon a couch or 
bed, with a thin coverlid over the body to equalize 
the heat of the surface. This precaution will shorten 
the duration of the attack considerably, and render 
it less likely to subside into a chronic sore throat, as 
many neglected cases do. The bowels should be kept 
relaxed by resort to some mild medicine, as castor-oil, 
salts, magnesia, or rhubarb. The free use of muci- 



ACUTE SORE THROATS. 



35 



laginotis drinks, such as barley-water, gum-arabic 
water, slippery-elm water, and the like, and of small 
fragments of ice retained in the mouth until melted, 
if agreeable, as they almost always are, will soothe 
the pain in the throat. Intense heat of the skin may 
be allayed by sponging the body with acidulated 
tepid water, bay-rum and water, or alcohol and water. 
This, with restriction to a very light and easily di- 
gested diet for a day or two, will be all that will be 
required in moderate and ordinary cases. Severe 
cases require the advice of the physician. 

Quinsy. — This is a severer form of sore throat, in 
which the inflammatory action is not confined to the 
mucous membrane, but involves the tissues beneath 
it. It is quite liable to go on to what is called sup- 
puration, or the formation of pus. The organ most 
prominently involved is the tonsil ; but the palate 
and uvula, the base of the tongue, the valve of the 
air-passage, the back of the throat, and the tissues 
that connect these various structures are all liable to 
be involved to a greater or less extent. It occurs 
more frequently in individuals with diseased tonsils 
than in other persons, and is most frequent in chil- 
dren and young adults. It is more dangerous in chil- 
dren than in adults, and in individuals with enlarged 
and diseased tonsils. 

Quinsy usually begins with a chill, and this is fol- 
lowed by fever within twenty-four hours. Pain in 



36 THE THROAT AND THE VOICE. 

the throat is an early symptom. All the visible struct- 
ures of the throat are inflamed and swollen, the ton- 
sils in particular — sometimes only one of them, some- 
times both of them, but usually one much more than 
its fellow. The swollen tonsil may project beyond 
the middle line of the throat, or the two tonsils may 
touch. They are usually covered with whitish or yel- 
lowish creamy secretions. The pain in the tonsil 
sometimes runs up along the fold behind it into the 
ear, with the vent-hole of which it is continuous 
(see page 15). There is indistinctness of speech, 
difficulty and pain in swallowing, and difficulty of 
breathing if the swelling is very great. The parts 
become dry, taste is impaired, and the breath offen- 
sive. Sometimes the saliva dribbles from the mouth 
because it cannot be swallowed. Sleep becomes diffi- 
cult or impossible when the mechanical impediment 
to breathing is great, or when the nervous system is 
excited by fever and suffering. Children are liable 
to delirium and convulsions. 

The disease lasts longer than common sore throat ; 
and though the tendency of the attack is to recovery 
in most instances, there are not a few in which it 
is fatal from the formation of burrowing abscesses, 
which inflict irreparable injury. In many instances 
an abscess forms in the tonsil, and when this bursts 
spontaneously, or is discharged by the surgeon's knife, 
relief to pain is usually immediate, and the inflam- 



ACUTE SORE THROATS. 



37 



matory process soon subsides, provided there are no 
more abscesses. An abscess that bursts spontaneously 
may suffocate the patient by flooding the air-passages \ 
but this is infrequent. It is best and safest, however, 
to submit to an operation, if suggested by the medi- 
cal attendant. A child, tormented for days by sleep- 
lessness from pain, will sometimes go to sleep on the 
lap of its mother or nurse, after the discharge of such 
an abscess, even before the surgeon has wiped his 
knife. 

Nothing is said about treatment of these cases, as 
they are too important to be intrusted to untrained 
hands. It is quite likely, however, that the use of 
gargles will be suggested in the treatment of this dis- 
ease. They are rarely of any service, chiefly because 
their use entails a great deal of pain. They may be 
entirely superseded, in the treatment of this and other 
forms of sore throat, by the use of sprays or douches 
propelled from the so-called atomizer, so frequently 
in use for diffusing sprays of cologne water and the 
like. The use of these sprays entails no pain, is 
really grateful and soothing, and the fluids reach the 
remoter parts of the throat which are never reached 
by the gargle. A gargle as ordinarily used only 
reaches the palate and base of the tongue, as a rule, 
as may be seen by experimenting with colored water 
— indigo water, for example. To reach the back 
part of the throat, it must be half swallowed ; a dif- 
4 



38 THE THROAT AND THE VOICE, 

ficult practice, and too painful for the subject of a 
sore throat. It is better to try and bring the fluid 
of the gargle in contact with the sore parts by hold- 
ing it in the mouth, and then gently turning the head 
to one side and to the other, backward and forward, 
so as to let the fluid bathe the parts in succession, 
without making any gurgling noise by forcing the air 
through it as in the usual method. Another good 
plan is to carry the fluid back to the root of the 
tongue in a teaspoon, and then pour it over the parts 
as the head is thrown back, which will bring it in 
contact with the deeper structures of the throat ; then 
the sides of the throat are bathed by appropriate 
motions of the head to either side ; and the process 
is completed by suddenly bringing the chin down to 
the breast as the fluid is ejected, so as to bathe the 
middle portion of the throat, the tonsils, palate, and 
roof of the mouth. 

Common Membranous Sore Throat. — It is highly 
desirable that the public should be aware that there is 
a comparatively unimportant disease of the throat in 
which the structures become covered with a membra- 
nous deposit, and which is often mistaken for diphthe- 
ria. The tendency in this disease being to sponta- 
neous recovery, and the disease being mistaken for 
diphtheria, certain remedies are apt to be vaunted as 
efficient in diphtheria, because they happened to be 
used vigorously in a case of common membranous sore 



ACUTE SORE THROATS. 



39 



throat which would have gotten well under ordinary 
management. 

This affection occurs at all seasons of the year. 
Some individuals are attacked almost annually. Its 
most frequent immediate cause is a cold bath, or 
other exposure to cold, while the body is overheated 
or in active perspiration. Imperfect drainage and 
emanations from cesspools and refuse-heaps are often 
the apparent remote cause. During the prevalence 
of diphtheria, common membranous sore throat is 
often contracted by persons susceptible to sore throats 
from other causes, and may then become a starting- 
point for the severer disease. 

It usually begins with a chill, followed by fever, 
which is sometimes quite severe \ then there are two 
or three days of ordinary sore throat. At first, the 
palate, tonsils, or pharynx are covered with groups 
of little vesicles, which burst, become excoriated, run 
into each other, and get covered by a grayish -white 
pellicle or membrane, resembling the similar false 
membrane of diphtheria, which begins, however, in 
another way and under other conditions. The vari- 
ous parts of the throat are swollen, but not nearly as 
much as in quinsy, and the affection is usually con- 
fined to one side. A similar form of sore throat 
sometimes attends advanced stages of consumption 
in which there has been severe disease of the throat. 
The disease usually subsides spontaneously in from 



40 THE THROAT AND THE VOICE. 

eight to ten days. Sometimes it is fatal, however, 
chiefly-in children, from extension of the membrane 
into the air-passages, death taking place mechanically 
by suffocation. It is difficult to distinguish this affec- 
tion from diphtheria, especially when the latter is 
prevalent; but there is not that profound disturbance 
of the system due to blood-poisoning, which is the 
chief characteristic of diphtheria. 

Common membranous sore throat often occurs again 
and again in some individuals, which is not the case 
with diphtheria. The appropriate treatment for this 
affection is that for ordinary sore throat, with such 
cleansing and astringent washes, sprays, and lozenges 
as the attendant physician deems suitable. 

The Sore Throats of Small-Pox, Measles, and 
Scarlet-Fever. — The sore throat of small-pox is due 
to the development of an eruption upon the surface 
of the throat, mouth, and air-passages similar to that 
which is developed upon the skin. It is liable to be 
followed by permanent hoarseness in those who re- 
cover ; and is quite apt to terminate fatally by ulcer- 
ation in the air-passages. 

The sore throat of measles is a catarrhal inflamma- 
tion of the nasal passages, throat, and air-passages. 
The mucous membrane of the throat is often affected 
a day or more in advance of the skin, the palate 
being covered with small red points. It is liable to 
be followed by prolonged hoarseness. 



ACUTE SORE THROATS. 



41 



The sore throat of scarlet- fever is very severe in 
some instances, to such an extent, indeed, as to be 
the main source of danger in that serious malady. 
Some amount of sore throat attends every case. In 
some cases it is the only manifestation. Susceptible 
nurses and physicians are liable to have sore throat 
nearly every time they are in attendance upon scar- 
latina. There is a diffuse inflammation of the throat, 
sometimes with small, pimple-like eruptions, and 
these manifestations appear a day or two in advance 
of the manifestations on the skin. 

The inflammation is of a high grade, not unlike 
that of quinsy in moderate cases, and proceeding to 
ulceration and great destruction of tissue in severe 
cases. The inflammatory process is very apt to ex- 
tend up into the drum of the ear and produce an 
abscess, which ruptures through the drum membrane 
and discharges externally at the outer ear. Many 
diseases of the ear are due to the sore throat of an 
attack of scarlet-fever. It is popularly beliered, and 
sometimes taught by physicians, that children will 
" outgrow' ' such affections. Nothing can be more 
erroneous. Every such case demands immediate 
and skilful treatment, in spite of which, not infre- 
quently, hearing is often impaired or lost. 



CHAPTER IV. 

DIPHTHERIA. 

DIPHTHERIA is one of those maladies known as 
blood diseases ; that is to say, it is due to some 
deleterious matter that gets access in some way to the 
mass of the blood, and poisons the system. The 
nature of this poisoning material has not yet been 
detected, but there is reason to believe that it flour- 
ishes where drinking-waters, and the air of dwelling- 
places, are impregnated with emanations from cess- 
pools, refuse heaps, waste-pipes, and unventilated 
sewer-drainage. The disease is propagable by con- 
tagion ; and one attack does not insure immunity 
from subsequent ones. Children are much more 
liable to it than adults. It is characterized by a low 
or typhoid type of fever, and more particularly by 
the development of a more or less copious deposit of 
what is termed false membrane on the mucous sur- 
faces of the throat and adjoining cavities, the air-pas- 
sage and nasal passages. Sometimes it extends along 
the gullet even into the stomach. It is likewise liable to 
be formed over any abraded portion of the skin. The 

42 



DIPHTHERIA. 



43 



character of the deposit varies from minute, delicate 
films to large, tough membranes, sometimes amount- 
ing to complete casts or moulds of great extent. 
The deposit is usually more or less diffused over the 
surfaces. The deposit may accumulate to such an 
extent in the air-passages as to produce death by 
suffocation ; but the more frequent cause of death in 
this notoriously fatal malady is extreme depression of 
strength and vitality, the result of the poison in the 
blood. 

The disease rarely occurs without exposure in some 
way to the cause of the infection, though it is some- 
times impossible to trace it to such an occurrence. 
Two to five days usually elapse between this exposure 
and the outbreak of the disease ; but this period may 
be but a day on the one hand, or be extended to two 
weeks on the other. 

The earliest manifestation to attract prominent at- 
tention is usually some degree of sore throat, often 
confined to one side, and attended with swollen glands 
below the ear and lower jaw of the same side, or both 
sides, as may be ; these parts being tender and pain- 
ful. Sometimes the swelling begins in the parotid 
gland in front of the lower part of the ear, — the same 
gland which is swollen in mumps. The throat be- 
comes swollen inside, where it soon becomes more or 
less overlaid or covered with a whitish deposit, usually 
commencing on the tonsil or the palate, and thence 



44 THE THROAT AND THE VOICE, 

gradually spreading ; but it may begin at points out 
of the line of sight, and thus escape detection. Cases 
occur, too, in which there is no local manifestation 
of deposit to be detected at any time. If the air- 
passages are to become involved, they become covered 
with the membrane within a day or two of its appear- 
ance in the upper part of the throat, or at least, ex- 
cept in rare instances, before the termination of the 
first week. When the air-passages are involved, the 
special symptoms are similar to those to be mentioned 
under the head of croup, and which become super- 
added to those of sore throat. While the deposit is 
spreading, the patient usually becomes more and more 
prostrated in strength. The disease is very apt to 
terminate fatally, especially in delicate and feeble 
persons, death taking place within a few days in some 
cases, and towards the end of the second week in 
most of them; exceptionally not until four or five 
weeks. Manifestations of recovery are usually pre- 
sented between the eighth and fourteenth day in most 
instances. Paralysis of the throat is not infrequent 
after recoveries from diphtheria, and the paralysis 
may extend to other parts of the body, especially the 
legs, and may even involve the heart and lungs, when 
it will be fatal. The eyesight is not seldom seriously 
affected from paralysis of the muscle of accommoda- 
tion or focusing. 

The treatment of diphtheria must be pursued under 



DIPHTHERIA. 45 

the direction of the physician, whose efforts are chiefly 
directed to sustaining the vital forces of the patient, 
providing for nutriment, and endeavoring to get rid 
of the accumulations in the throat, nose, and air-pas- 
sages. There are some general points, however, with 
which heads of families should become familiar. The 
patient should be isolated as much as practicable, to 
prevent spread of contagion ; and all the clothing, 
food and bed-utensils be at least partially disinfected 
before they are removed and carried through the house. 
Carbolic acid water is the most available agent for this 
purpose in most instances. The mode of using it may 
be learned from the physician. Carpets, curtains, and 
stuffed furniture should at once be removed from the 
sick-room, which ought to be at the top of the house, 
and well ventilated. After the case is over, this room 
and all it contains should be thoroughly disinfected 
by exposure to the fumes of burning sulphur, in order 
to lessen to a minimum the danger of infection for 
future occupants. When the deposits in the throat 
are dry and adherent, it is considered very import- 
ant, by many physicians, to keep up an abundance of 
moisture in the room by means of dishes of boiling 
water, wet cloths hanging about, and the like, in the 
hope of keeping the matters in a fluid state, so that 
they may be more easily expelled from the body. 
Systematic inhalations of steam are also used at ap- 
propriate intervals in addition. When the mem- 



46 THE THROAT AND THE VOICE. 

branes are in the air-passages, it is very important 
that they should be coughed out, lest they accumulate 
in quantity dangerous to breathing. To favor their 
detachment and expulsion, it is customary with many 
physicians to see that a large stock of unslaked lime 
is in the house. When the dreaded time comes, this 
lime is broken into fragments the size of furnace coal, 
and a few of them at a time are slaked by the bed- 
side, the fumes from the lime being directed towards 
the mouth of the patient by some extemporized 
method, such as covering the vessel with a big paper 
bag, as a flour bag, with one of the corners torn out 
so as to direct the fumes through it. This process is 
repeated every half-hour, hour, or at longer intervals, 
as may be required. Sometimes, in addition, a piece 
of lime is kept in a vessel of heated water by the bed- 
side, so as to maintain a continuous evolution of steam 
and lime particles. The lime gets into the air-pas- 
sages and detaches the membranes, and the steam gets 
beneath them through these inlets and loosens them, 
so that they can be coughed up. The masses may accu- 
mulate in the throat and mouth and the patient be 
unable to eject them ; and they may require removal 
with the finger of the nurse or attendant. 

In some cases where the upper air-passage becomes 
so occluded, or so paralyzed that sufficient air cannot 
get through to sustain life, it becomes necessary for a 
surgeon to cut a hole into the windpipe, and keep it 



DIPHTHERIA. 47 

open, until the passage above becomes sufficiently 
pervious again. This operation (tracheotomy) is not 
always successful. More than half the children oper- 
ated upon die in spite of it, and it is very rarely indeed 
that it saves the life of an adult. The reason is that 
the air-passage of the adult is so large in proportion, 
that the disease in the smaller tubes is too far ad- 
vanced for recovery before the larger calibre of the 
air-passage gets obstructed. The operation is per- 
fectly justifiable in children, however, and hundreds 
are saved by it from otherwise inevitable death. It 
permits them to breathe while they are going through 
the course of the disease towards death or recovery, as 
may be, but is not in itself curative. The earlier it 
is performed, after it appears requisite, the better the 
chance of saving life by it. 

The importance of this operation is so great, that 
it is questionable, in many instances, whether parents 
are not culpable in refusing to allow their children 
this chance for life when urged upon them by their 
medical advisers. The fact that no certain promise 
of success can be given by the surgeon in any one 
case, does not begin to counterbalance the fact that 
lives are often saved by it, even under conditions 
apparently utterly hopeless, occasionally even directly 
after the patient has ceased to breathe. Even when 
unsuccessful in saving life, the operation often ensures 
freedom of breathing, and saves a dreadful death by 



4 8 



THE THROAT AND THE VOICE, 



suffocation. The ease which follows, justifies the op- 
eration merely as an alleviator of distress. 

Another point which should be realized by parents 
is the great danger of lifting a patient, low with 
diphtheria, in disobedience to the physician's injunc- 
tions. The heart becomes so feeble, at times, that the 
extra exertion necessary to pump the blood into the 
upper part of the body against gravity is too much 
for it, and it ceases to beat. The physician knows 
when this is imminent, and tells the attendant not to 
allow the patie?it to rise or be raised for any purpose 
whatever, until he deems such precaution no longer 
necessary. 



CHAPTER V. 



CROUP. 

THERE is a spasm of the air-passage sometimes 
called pseudo-croup or false croup, (see page 78 ;) 
but it is of nervous origin altogether, and has no af- 
finity with croup other than that the main symptom 
is always spasm, which also occurs in some cases of 
croup, but is by no means a constant manifestation. 

True or membranous croup is chiefly an inflamma- 
tory disease of the upper air-passage, attended with 
the deposit of a membrane like to that which accu- 
mulates in the air-passages in diphtheria. The de- 
posit may extend along the windpipe, and even great 
distances along the bronchial tubes and their ramifi- 
cations. There are no reliable chemical or micro- 
scopic tests which can distinguish between the deposits 
in croup and in diphtheria. On this account many 
physicians consider the two diseases to be identi- 
cal. Others, among them the author, believe that 
they are not identical, and that there is no primary 
or special blood-poison at work in croup as in diph- 
theria, and that the danger to life in croup resides 
5 D 49 



5<D THE THROAT AND THE VOICE. 

wholly in the locality of the inflammatory process 
and its mechanical results. In this view, croup is not 
to be regarded with the same dread as diphtheria, 
though it is also often fatal. It rarely attacks adults. 

The false membrane in croup sometimes exists in 
the accessible portions of the throat, and then its re- 
semblance to diphtheria is so great, that only the 
absence of the symptoms of a low form of fever can 
distinguish it. 

A frequent cause of inflammatory or true croup, 
if not the chief one, is the vicious method, so much 
in vogue by silly and vain parents, of leaving chil- 
dren partly undressed, to show off their pretty necks, 
shoulders, and legs. This practice causes an unequal 
temperature of the surface, and renders the little vic- 
tims of parental vanity extremely susceptible to ill 
effects from slight exposure to cold and dampness. 

The special symptoms of croup are hoarseness, soon 
increasing to loss of voice, with increasing difficulty 
of respiration, attended at times by severe and noisy 
efforts of inspiration, and sometimes terminating in 
suffocation from accumulation or unfavorable position 
of the false membrane, or even, at times, from spas- 
modic closure of the upper part of the air-passage, or 
paralysis of the muscles that keep it open during 
health. There is usually some little fever with slight 
catarrh or cold for a day or two, attracting but little 
attention, with a moderate amount of cough and 
hoarseness. Then there is a flushed face, towards 



CROUP. 51 

evening generally, with undue brilliancy of the eye, 
increased heat of skin, and abnormal frequence of 
pulse ; and towards midnight the little patient is 
awakened with a paroxysm of difficult breathing, 
often the first symptom to excite alarm. The cough 
becomes shrill and harsh, like the sound of a cock's 
crow or a blast through a brass trumpet. The cough 
and the voice gradually become muffled, and finally 
may become extinct, so that the child is seen to cry 
and cough without making noise enough to attract 
attention. The difficulty of respiration increases as 
the matters accumulate in the air-passages ; and the 
soft parts above the chest, below the chest, and 
between the ribs, become more or less deeply in- 
dented or depressed by external atmospheric pressure 
at each ineffectual attempt to expand the lungs by 
inspiration. The child tries to grasp something to 
help its breathing, often clutches at its throat, and 
exhibits the most unmistakable evidences of threaten- 
ing suffocation. If not relieved spontaneously or 
otherwise, the flush fades from the face, the lips 
become pale and then livid, perspiration pours out 
over the surface, and the efforts at respiration become 
less and less vigorous, until they cease in the death 
struggle. 

In the treatment of croup there are the same in- 
dications for the use of steam- and lime-fumes as in 
the analogous condition of diphtheria, as well as for 
the operation of incising the windpipe for access of 



52 THE THROAT AND THE VOICE. 

air to the lungs when there is uncontrollable occlu- 
sion above it. In the two diseases, the great points 
promising success, are a disposition to cough and a 
desire for food ; and everything should be subservient 
to encouraging these conditions. It is highly neces- 
sary that skilled assistance be continuously at hand 
for at least the first twenty-four hours after the wind- 
pipe has been opened, as the life of the child may be 
imperilled by sudden occlusion of the artificial pas- 
sage, demanding instantaneous attention to avert im- 
mediate death. The chances of saving life by timely 
tracheotomy in true croup are infinitely greater than 
they are in diphtheria, because there is no blood-poison 
at work, and the main indication is fulfilled if the 
mechanical obstruction to respiration is overcome. 
The foreign matters are to be viewed in the light of 
foreign bodies accidentally inhaled into the air-pas- 
sages and threatening suffocation from mechanical 
obstruction to the access of air to the lungs. If the 
accumulations in croup plug up the smaller air-pas- 
sages, or even the windpipe below the point at which 
an opening can be made, the chances of success from 
the operation are diminished. To be successful, the 
operation must not be delayed too long ; for if car- 
bonic acid accumulates in the blood from prolonged 
want of due oxygenation, the patient may die, poisoned 
from this cause, even several days after a tracheotomy 
successful so far as procuring freedom of respiration 
is concerned. 



CHAPTER VI. 



ACUTE LARYNGITIS; 



LARYNGITIS is the name employed to designate 
j inflammation of the larynx. Acute laryngitis is 
a severe inflammation of the larynx, very apt to be 
confounded with croup, when it occurs in children, 
and with various other affections in both children and 
adults. It is exceedingly dangerous to life because a 
moderate amount of swelling, inseparable from severe 
inflammation, which would be of much less imme- 
diate importance in any other part of the body, is 
liable here to close up the narrow air-passage to such 
a degree as to interfere with breathing, and thus lead 
to death by choking or suffocation. A violent form 
of laryngitis, due to accidental swallowing or inspira- 
tion of acrid and caustic substances, has already been 
alluded to (page 30). 

The special affection to which attention is here di- 
rected, however, is an inflammation of the lining 
membrane of the larynx, due usually to sudden ex- 
posure to cold, in a person subject to severe sore 
throat, or convalescing from some disease in which 
5* 53 



54 THE THROAT AND THE VOICE. 

the throat has been affected. It also occurs, under 
similar circumstances, during the chronic sore throat 
that attends many cases of consumption of the lungs. 
Sometimes it is due to prolonged or violent scream- 
ing, or other excessive use of the voice; sometimes to 
inhaling some noxious matters in the air; sometimes 
to extension from some local disease in the mouth or 
jaw, as an inflamed gum during teething, and the 
like. Sometimes it is the result of the poisonous 
action of certain drugs, when given in excess or in- 
judiciously, especially those containing mercury, an- 
timony, and iodine. 

In some cases the inflammatory action is confined 
to the larynx ; in others, it is associated with similar 
disease in the windpipe, or in the upper part of the 
throat. The great danger in this disease is the for- 
mation of a dropsy of the tissues, which become 
filled with watery fluid which has oozed out of the 
blood-vessels, and thus flap like loose bags upon the 
top of the windpipe at each inspiration, and so pre- 
vent due access of air to the lungs. 

The disease usually begins with a chill, soon fol- 
lowed by fever, and before long by sore throat. The 
patient complains first of pain in the larynx, which 
is increased by talking, coughing, or access of cold air 
to the parts ; and there is after awhile a sense of con- 
striction, as if something had gotten into the top of 
the air-passage, or something were squeezing it from 
the outside. Sometimes there is spasmodic catching 



ACUTE LARYNGITIS. 55 

of the breath. These signs are soon followed by actual 
difficulty of breathing, and with difficulty in swallow- 
ing. The voice is hoarse, and its exercise often pain- 
ful. The sounds of breathing become harsh, like in 
croup. There is a similar sort of cough, too, usually 
accompanied by expectoration of phlegm or mucus, 
which gives relief for the time-being. 

Mild cases usually get well in from five to eight 
days or more ; but they are liable to become severe 
suddenly. There is no way of absolutely determin- 
ing the condition of the parts without examining 
them by means of a mirror placed in the back part 
of the throat so as to reflect the light down {lar- 
yngoscopy) ; but the general symptoms and history of 
the attack are usually sufficient to indicate its nature. 

The treatment requires the assiduous care of the 
intelligent physician, and valuable time may be irrep- 
arably lost by attempting home treatment. Pending 
the arrival of a physician, the patient should be put 
to bed, with iced cloths around the throat, and bits 
of broken ice should be at hand for almost constant 
use in the mouth ; while a smart purge of half an 
ounce or an ounce of Epsom-salts, for the adult, 
should be promptly administered, so as to produce one 
or more full watery evacuations from the bowels. 

After recovery from an attack of acute laryngitis, 
great care should be exercised, for some weeks, in 
avoiding everything which might be liable to induce 
sore throat. 



CHAPTER VII. 

CHRONIC SORE THROATS. 

CHRONIC Sore Throats are sore throats of con- 
siderable duration — weeks, months, or years, as 
the case may be; the patient, as a rule, not being 
confined to the house, unless suffering from some 
enfeebling malady, or very much reduced by the 
sore throat itself. 

In some cases they are the result of one or more 
attacks of acute sore throat. In others, they are the 
gradual result of prolonged exposure to irritating 
dust, chemical products and the like, as in store- 
keepers, factory hands, stone-cutters, stokers, photog- 
raphers, workmen in chemical laboratories, and so 
on. Then, again, they occur without any assigna- 
ble cause, attracting little attention until they have 
existed for a long time. 

Simple Catarrhal Chronic Sore Throat is the 
mildest form of the affection. It affects the mucous 
or covering membrane of the palate and pharynx, and, 
not infrequently, of the back part of the tongue also, 
and even the floor of the mouth far back. It is rec- 

56 



CHRONIC SORE THROATS. $f 

ognized by the bulging forward of the mucous mem- 
brane in irregular ridges. The membrane looks red 
and pasty-like, and is often overlaid by enlarged and 
tortuous blood-vessels. There is an irregular accu- 
mulation of mucus or phlegm at various points. The 
general health is often unimpaired, though there may 
be languor and indisposition to exert one's self. It 
is often merely an indication of disorder of the stom- 
ach or some other portion of the digestive tract. 

The symptoms are those of local discomfort in 
the throat, with dryness of the parts, and a dispo- 
sition to expectorate the phlegm that accumulates 
from time to time : but actual cough is not frequent, 
except to clear the throat out on rising in the morn- 
ing. An unpleasant and disagreeable taste in the 
mouth is often a marked feature of the complaint. 

As the disease is usually associated with disease of 
the digestive apparatus, proper attention to the latter 
will often cure the sore throat without special treat- 
ment. Where this does not suffice, or where the dis- 
ease is not associated with disease of the digestive 
apparatus, soothing solutions in sprays are indicated 
— warm, tepid, or cold, as may be most grateful to the 
parts. Severe measures, such as cauterization and 
swabbing out of most kinds, are more apt to be inju- 
rious than beneficial. Gargles rarely reach all the 
diseased structures, and sprays are therefore to be 
preferred. (See page 37.) Lozenges of gelatine, 



58 THE THROAT AND THE VOICE. 

gum-arabic, real marsh-mallow (not the factitious 
marsh-mallow paste and gum-drops sold in the shops, 
which do not contain an iota of marsh-mallow), ex- 
tract of liquorice, and the like, are often of great 
service. It usually requires a number of months to 
get rid of the affection, but the cure is apt to be 
permanent. When smoking keeps up the sore throat, 
or prevents it cure, the habit must be abandoned or 
suspended. 

Chronic Folltculous Sore Throat is a severer 
grade of sore throat than that last mentioned, and is 
the most frequent form of the affection in the United 
States. It consists not only in disease of the mucous 
membrane, but, also, and especially, in disease of the 
glands (or follicles) which are imbedded in the 
mucous membrane. It is that form of sore throat 
popularly termed clergyman' s or clerical sore throat ; 
but it is by no means confined to the clergy, or even 
to individuals who make special use of the voice, 
although very prevalent among them, and often due 
to improper or injudicious use of the voice, especially 
when suffering from slight sore throat, as will be de- 
tailed in the latter part of this volume. Its preva- 
lence among clergymen seems to be in part due to 
the inequalities of temperature to which they are 
often subjected in the performance of their duties, 
with bare head exposed to draughts from open win- 
dows or in the open air. It has often been stated 



CHRONIC SORE THROATS. 59 

that clergymen who preach extemporaneously or 
without manuscript, are less liable to the complaint; 
and this may be so, as far as the constrained position 
of reading from a desk interferes with the freedom 
of respiratory movement so essential to the favorable 
use of the voice without sensible effort. It occurs 
very often in wine -bibbers. It is not confined to the 
structures mentioned in connection with the simple 
catarrhal form of chronic sore throat (page 56), but is 
apt to involve the glands at the posterior portions of 
the nasal passages, the roof or vault of the pharynx, 
the glands in the base of the tongue and floor of the 
mouth, and those in the outer and inner mucous 
membrane of the larynx. It often occurs in scrofu- 
lous persons, in those subject to diseases of the skin, 
in those predisposed to consumption, gout, rheuma- 
tism, and other hereditary maladies, but is by no 
means confined to these classes of individuals. It is 
more frequent in the delicate than in the robust. 

City life seems to favor the development of this 
affection, the evil results being due to inhaling the 
dusts, chemicals, and decomposing emanations, and 
so on, in the atmosphere of great manufacturing 
communities. These irritate the mucous membranes 
with which they come in contact, and set up an un- 
healthy secretion from the glands, which eventually 
stops up their outlets, and causes them to enlarge in 
the manner characteristic of the complaint. 



60 THE THROAT AND THE VOICE. 

The earliest intimation of the disease is usually a 
sensation of dryness in the throat with a disposition 
to expectorate, which may comprise the sum total 
of symptoms for a period of indefinite duration. If 
the disease continues, there will be more or less 
hoarseness, sooner or later, with inability to depend 
upon the voice for any unusual use of it. There may 
be some difficulty in swallowing, as the disease pro- 
gresses, and some degree of impairment of hearing. 
There is rarely any actual pain in the parts, but 
rather a sense of discomfort as from the presence of 
some material which ought not to be there. Head- 
ache is apt to occur when the disease involves the top 
of the pharynx at the base of the skull. Dyspepsia 
and other disorders of digestion are not uncommon. 
The saliva and other secretions from the glands of 
the mouth, being wasted in expectoration and dete- 
riorated in quality, are unfit for their normal use in 
assisting the digestion of starchy articles of food, 
which, therefore, reach the stomach but partially 
prepared for stomachic digestion, and excite dyspepsia. 
Indigestion impairs the quality of the blood, and 
brings in its train undue coolness of the extremities, 
and other evils. Though a general condition of im- 
paired vigor ensues, there is rarely sufficient sense of 
ill-health to interfere with the ordinary requirements 
of business or other occupation ; but all the ordinary 



CHRONIC SORE THROATS. 



61 



work is done with some amount of effort to keep up 
to the work. 

If the disease progresses, — and it often remains at a 
stand-still, — the symptoms become aggravated, espe- 
cially after unusual exertion or exposure. The voice 
may become so impaired as to interfere with the per- 
formance of public duties. Cough is more frequent, 
and the expectoration more viscid, and often accom- 
panied by painful sensations deep down in the throat 
or at the root of the tongue ; the patient becomes ner- 
vous, and experiences difficulty in swallowing at times, 
and in breathing at times ; all of which adds to the 
mental disturbance that begins to be manifested, lest 
the disease be associated with disease of the lungs, or 
be indicative of some incurable malady. 

The characteristic local manifestation of the disease 
is a series of groups of enlarged follicles in the back 
part of the throat, easily recognized as small, irreg- 
ular, red elevations at various points of the surface. 
With this the outlines of distended blood-vessels are 
more or less prominent. Strands of unhealthy mu- 
cus sometimes adhere to the throat. The general 
surface often looks excoriated as if something rough, 
like a fragment of sandstone or a small nutmeg grater, 
had been drawn over it. It is very rarely, indeed, 
that these enlargements undergo ulceration, and when 
they do, it is in individuals either much broken down 
in health, or of decidedly scrofulous constitution. 
6 



62 THE THROAT AND THE VOICE. 

It is a significant fact, that this disease of the throat 
does not, as a rule, follow a direct line down into the 
gullet or food-pipe, but goes along the larynx or top 
of the windpipe. This is due to the constant patency 
of the air-passage, while the food-pipe is only open 
during the special acts of swallowing. The special 
symptoms of this disease are impairment of voice, im- 
pairment of swallowing, impaired respiration, cough, 
impairment of hearing, and pain. These occur in 
varying grades, and are not all present in every case. 

Impairment of voice includes all degrees of feeble- 
ness and hoarseness ; and its manifestations may be 
intermittent or more or less continuous. It is usually 
due to involvement of the mucous membrane and 
glands of the larynx ; but is sometimes altogether 
due to reflex action in the great pneumogastric nerve, 
which supplies both pharynx and larynx, as well as 
other structures. Just as a sip of water swallowed 
during an address, although it does not enter the 
larynx, where it would excite cough, clears up a mo- 
mentary hoarseness by the reflex action of the cold 
and moisture transmitted from the pharynx to the 
larynx, just so a disease in the pharynx may produce 
manifestations in the larynx, without there being any 
direct involvement of the tissues of the latter. 

Impairment of swallowing may be extremely trifling, 
and vary from that grade even to actual inability to 
swallow, though this extreme is rare. In some in- 



CHRONIC SORE THROATS. 63 

stances the effort of swallowing is usually attended 
with pain, and sometimes with spasmodic sensations. 
Sometimes it is altogether nervous. Sometimes it is 
due to enfeeblement of the muscles from actual loss 
of substance. Occasionally it is due to ulceration. 

Cough maybe limited to a mere "hem" to rid 
the parts of uncomfortable sensations, and vary to 
extreme efforts to get rid of tenacious mucus that 
clings in strands to the abraded mucous membrane. 
In severe cases, especially when there is ulceration, 
the expectoration may be occasionally tinged with 
blood from rapture of delicate blood-vessels in vio- 
lent paroxysms of cough. 

Impaired respiration is usually nervous and reflex. 
In some instances, however, the glands in the upper 
part of the pharynx, and in the region bounding the 
outlets of the nasal passages into the throat, are en- 
larged, and occlude the nose behind, so as to compel 
almost continuous breathing through the mouth. 

Impairment of hearing sometimes attends this dis- 
ease, and is occasionally permanent, even after the 
throat has been cured. It is due to an extension of 
morbid disease up the vent-tubes of the drum of the 
ear, which open into the throat, one on each side of 
the respective posterior outlets of the nasal passage. 
In fact, the great majority of cases of impaired 
hearing from disease of the drum of the ear, and its 
contents and connections, are due to extension of 



64 THE THROAT AND THE VOICE. 

disease of the throat propagated in the direction just 
indicated. 

Actual pain is infrequent, but uncomfortable sensa- 
tions in the throat, as from minute or adherent foreign 
bodies, such as hairs, bristles, and the like, are quite 
common. 

Enlargement or prolongation of the uvula so that its 
tip tickles the base of the tongue, or even the epi- 
glottis, exists in some instances, and produces such 
disagreeable tickling as to provoke cough to get rid 
of it. 

The treatment of this affection is tedious, but may 
be almost always satisfactory if properly instituted. 
Constitutional treatment is required in most instances, 
appropriate to the demands of the case, in maintain- 
ing the functions of the skin, stomach and intestines, 
and other organs, in as healthy a state as practicable. 
Any hereditary taint of scrofula, gout, rheumatism, 
or the like, requires appropriate measures accordingly. 
Tonics are often required. In certain cases, what 
are called nerve-tonics are especially requisite. Lo- 
cal treatment of the throat is almost always necessary. 
This consists in certain applications to the diseased 
follicles, for the purpose of getting rid of them by 
absorption, if practicable, or by actual destruction, if 
necessary. This requires careful manipulation at the 
hands of the medical attendant, or a duly qualified 
assistant, who has been carefully instructed by the 



CHRONIC SORE THROATS. 



65 



physician. It cannot be done effectually by one's 
self. In addition to this, the frequent use of sprays, 
such as have already been mentioned (page 37), are 
likewise of advantage. 

Rest from vocal effort is often imperative, and in 
many cases absolutely indispensable to a cure; es- 
pecially in those individuals to whom the use of the 
voice is a means of livelihood. It is chiefly the im- 
practicability of resting the vocal organs that pro- 
longs the treatment of the disease. Improper meth- 
ods of speaking must be corrected. (See Improper 
Use of the Voice, and Care of the Voice.) 
6* E 



CHAPTER IX. 

CHRONIC LARYNGITIS. 

THIS is a chronic or long-continued inflammatory 
disease of the larynx, or larynx and windpipe, 
which may simply involve the lining and covering 
mucous membrane, or the lubricating glands in the 
membrane, or the tissues beneath, including the 
blood-vessels, nerves, muscles, and even the frame- 
work or skeleton of the parts. Sometimes it follows 
as the result of one or more attacks of the acute in- 
flammatory affection of the same parts. Sometimes it 
is part and parcel of a chronic bronchitis or inflam- 
mation of the air-passages generally. Sometimes it 
is due to over-use or abuse of the voice; sometimes 
to the irritating effects of dust and other matters 
inhaled. Sometimes it is part and parcel of a cer- 
tain variety of consumption of the lungs, in which 
case it is popularly known as consumption of the 
throat ; but it is not positively known to exist in this 
form, unless the lungs are already in a state of dis- 
ease. 

Chronic laryngitis of all kinds is more frequent in 
adults than in children, and in males than in females. 

68 



CHRONIC LARYNGITIS. 69 

When the disease is confined to the mucous mem- 
brane, it is usually in what is known as the catarrhal 
form, characterized by an excessive secretion of mucus 
or phlegm, which is expectorated by coughing. There 
are occasional or temporary sensations of pain in the 
parts, with more or less hoarseness, and, in some 
cases, a certain and variable amount of impairment 
in swallowing ; but the general health is fairly good, 
unless the amount of secretion is very great and ex- 
hausting. The expectoration of mucus is usually 
greatest on rising from bed in the morning, to evac- 
uate the accumulation over night. The affection is 
sometimes associated with the forms of chronic sore 
throat already described. 

In some cases, as in scrofulous subjects, and es- 
pecially in those of consumptive tendency, the dis- 
ease is manifested to a great extent in the glands of 
the mucous membrane. These glands increase in size 
and in number; and when this takes place at the upper 
inlet of the air-passage, as is most frequently the case 
in the beginning, there may be sufficient swelling to 
interfere seriously with comfortable breathing, and 
to a certain extent with freedom in swallowing. 
There is greater cough and expectoration than in the 
simply catarrhal form of the disease, which always 
coexists with this glandular form. 

In consumptive individuals, the glands eventually 
ulcerate, and sores are left, which very rarely heal of 



yO THE THROAT AND THE VOICE. 

themselves, or even under the most judicious manage- 
ment. The disease also penetrates into the deeper 
tissues, which are often destroyed and coughed out 
in small fragments. Sometimes an acute inflamma- 
tion is produced by the disease of the skeleton or 
cartilages of the larynx, and dropsy of the parts 
occurs, somewhat like that described in connection 
with acute laryngitis (page 54); but it is more grad- 
ual, and rarely as extensive. On the other hand, it is 
much less susceptible of cure or amelioration. Indeed, 
the great majority of cases are not at all susceptible 
of cure. When this ulceration occurs, it is almost 
always evident that it has been preceded by ulcera- 
tion of the lungs, and the two processes are almost 
certain to exhaust the individual. As the disease 
progresses, the hoarseness increases often to loss of 
voice. Towards the last, swallowing becomes ex- 
tremely difficult, and absolutely impossible in some 
cases, so that there is an unhappy prospect of starva- 
tion, if it is impossible to nourish the invalid by 
means of the stomach-tube, or by nutritious fluids 
thrown into the bowel. The disease is rarely very 
rapid in its course ; not quite so rapid, indeed, as in 
the severer forms of slow consumption of the lungs 
alone ; the average tenure of life, after the develop- 
ment of the disease, being from four to seven years 
under good management. 

The o^'iy means by which this disease can be de- 



CHRONIC LARYNGITIS. 



71 



tected in its earlier stages is by the use of a little 
mirror passed into the mouth so as to reflect the 
image of the parts upon its surface. A pallid condi- 
tion of these parts, with evidence of glandular swell- 
ing at the top of the windpipe, always indicates the 
suspicious character of the affection ; and if there is 
impairment of the lungs, and a consumptive family 
history, there is rarely any doubt as to its nature. 

The treatment of the disease consists in all those 
measures of invigoration which are practised in con- 
sumption of the lungs; with such local treatment, by 
inhalation and otherwise, as the condition of the 
larynx and windpipe may require. These can only 
be judiciously instituted under the supervision of the 
physician. Attempts at home treatment, without 
medical advice, are injudicious, and likely to cause 
the loss of valuable time ; for it is only in its earlier 
stages that the disease is at all susceptible of cure. 

Many cases of sore throat, with loss of voice, cough, 
and difficulty in breathing and in swallowing, are 
attributed to this throat consumption, when they are 
due to some other and much more remediable cause. 



CHAPTER X. 

FOREIGN BODIES IN THE THROAT AND WINDPIPE. 

FOREIGN bodies sometimes become lodged in 
the throat or windpipe. These may be ill-fitting 
plates of false teeth ; * large morsels of food or frag- 
ments of bone arrested, or "going the wrong way" 
during eating; pins and tacks and the like held in 
the mouth temporarily ; toys, coins, and other objects 
placed in the mouth during play, and so on. If the 
foreign body be arrested in such a manner as to pre- 
vent breathing, sudden death by suffocation may ensue. 
The usual symptoms of the entrance of a foreign 
body in the throat or air-passages, are sudden parox- 
ysms of pain, or coughing, and gasping for breath. 
Sometimes the paroxysm is immediately fatal, as has 
been mentioned. In most instances the intruder is 
expelled. In a great number of cases, a foreign body 
remains in the air-passage and cannot be expelled by 
voluntary effort. It then produces repeated parox- 
ysms of cough and suffocation, more or less frequent, 
according to the position of the foreign body, which 
may vary from time to time. 

* Plates of false teeth should always be removed on going 
to sleep, for fear of an accident. 

72 



FOREIGN BODIES IX THE THROAT, ETC. 73 

An individual with a foreign body in the air-pas- 
sage is never safe. A fatal paroxysm may ensue at 
any moment, on slight provocation. It is essential, 
therefore, that due efforts be made for its removal or 
expulsion. In many instances it becomes requisite 
for the surgeon to make an artificial opening into the 
air-passage (tracheotomy), and extract the body thence 
with forceps. 

In cases of the kind, a physician should be promptly 
summoned. Pending his arrival, attempts maybe made 
to excite vomiting by tickling the throat deep down 
with a feather; or to excite effective cough by bending 
the body well forward and having some one strike the 
back smartly during each successive act of cough. Small 
children can be held up by the legs, head downwaid. 

Should the body not be expelled, and the paroxysm 
cease, rest of body should be enjoined until skilled 
assistance can be procured. Irrational and haphazard 
efforts to get rid of the body are very apt to be in- 
jurious. Attempts may be made to reach the body 
by the forefinger, which can sometimes be hooked 
around it to detach it when high enough up. Some- 
times, when the body is a smooth one, as a pebble or 
coin, and is caught in the windpipe, it may be removed 
by letting the individual bend himself backward 
towards the floor from the arm of a sofa or the like, 
upon which he is first to sit, when the body will roll 
down by gravity into the mouth. 
7 



CHAPTER XI. 



TUMORS IN THE THROAT AND WINDPIPE. 

WARTS and various other tumors are developed 
in the throat and windpipe, just as in other 
regions of the body. They give rise to cough, hoarse- 
ness, and difficulty of breathing, swallowing, or articu- 
lation, according to their location, size, and mode of 
attachment; but they rarely occasion pain. These 
symptoms are often erroneously referred to other dis- 
eases. Such growths usually result from catarrhal 
inflammations of the surfaces on which subsequently 
they become developed. Croup and measles are 
sometimes productive of them. When quite large, 
or very movable, their presence may be suspected by 
the character of the breathing. As a rule, however, 
they are only discoverable by observing their image in 
a little mirror held in the mouth. They usually re- 
quire removal by some variety of surgical procedure, 
internal remedies being adequate for their absorption 
only in exceptional instances. 

74 



CHAPTER XII. 

PARALYSIS OF THE THROAT. 

PARALYSIS of the throat occurs in various forms 
as the result of disease or injury. Paralysis of 
the palate is recognized by its relaxed condition and 
the sluggishness with which it contracts on touching 
it with some foreign body, as the finger or a lead- 
pencil. In some cases it does not contract at all. 
This form of paralysis sometimes follows diphtheria, 
but occurs in many other diseases likewise. There is 
a nasal twang to the voice, and great difficulty in swal- 
lowing fluids, portions of which escape into the upper 
part of the pharynx, and thence run out by the nasal 
passages. 

Paralysis of the pharynx is indicated by difficulty in 
swallowing, or even inability to swallow. The muscles 
of the pharynx fail to contract on contact of foreign 
substances. This form of disease is sometimes a man- 
ifestation of hysteria, as indeed is, sometimes, paral- 
ysis of any other portion of the throat, or indeed of 
any other portion of the body. 

As will be explained in the article on voice, there 

75 



7 6 THE THROAT AND THE VOICE. 

are two vocal bands at the top of the windpipe which 
are held asunder during ordinary respiration, and which 
are brought together during phonation or use of the 
voice. Now, some or all of the muscles by means of 
which these vocal cords are brought into apposition, 
may become paralyzed, in which case there will be 
more or less hoarseness, or even absolute loss of voice, 
according to the nature and degree of the paralysis. 
Again, the muscles which separate the vocal cords in 
breathing may become paralyzed, and then there will 
be no loss of voice, nor even hoarseness in most cases, 
but there will be great difficulty in getting the air to 
enter the air-passages, the symptoms being much like 
those mentioned under the head of croup. 

The management of these various forms of paralysis 
requires treatment of the malady or injury by which 
they may be occasioned, and, very often, appropriate 
treatment by electricity, under the care of a com- 
petent physician. Paralysis preventing swallowing 
may require the introduction of a stomach-tube in 
order to feed the individual by the mouth ; or the use 
of nutritive enemas to feed him by the bowel. Pa- 
ralysis preventing due inspiration of air may require 
an artificial opening in the windpipe, below the seat 
of the disease, and the permanent use of a tube to 
keep the artificial orifice open until the paralysis is 
overcome, if it be at all remediable. 



CHAPTER XIII. 

SPASM OF THE THROAT. 

INVOLUNTARY contractions of the muscles of the 
throat sometimes occur, and are occasionally very- 
serious, even to such a degree as to imperil existence. 
Thus, when the contractions take place in the muscles 
at the top of the windpipe, air cannot get through it 
into the lungs, and the individual necessarily suffo- 
cates, if the spasm does not relax in one or two min- 
utes. Usually, however, the accumulation of car- 
bonic acid in the blood, as a result of the spasm, 
produces a peculiar relaxing effect, due to carbonic 
acid gas poisoning, and, as the muscles relax, the air 
rushes into the air-passages with a stridulous noise, 
the blood becomes oxygenated again, and this oxygen- 
ation, in its turn, overcomes the threatened poisoning 
by carbonic acid gas. This is the condition which 
exists in the affection known as spasmodic croup. 

Spasmodic Croup is a term long used, though im- 
properly, to designate a peculiar disease to which 
children are subject during the first few years of 
7* 77 



78 THE THROAT AND THE VOICE. 

life, though it occasionally occurs at a later period 
also. There is a sudden spasmodic closure of the 
vocal bands at the top of the windpipe, between which 
the air passes uninterruptedly in ordinary breathing. 
This interferes with inspiration, and the forced effort 
to inhale the air produces a characteristic noise (vocal 
stridor) as it passes the very narrow chink between 
the vocal bands. This sound is almost identical with 
that which occurs in some cases of true croup, or of 
whooping-cough, or when some local irritant has got 
into the windpipe, or the tube leading to it. On ac- 
count of the similarity of this sound to that produced 
in forced inspiration in croup, the disease has been 
termed " false croup," "spasmodic croup," and so on. 
But it is not croup, for there is no inflammation, and 
no development of a morbid product to interfere 
with the breathing. It is a spasm, owing to disease 
of the nerves of the parts, usually due to indirect 
or reflected influence from irritation in the mouth, 
stomach, intestinal canal, spinal column, and so on. 
It occurs during teething, indigestion, and other con- 
ditions, and is much more frequent in scrofulous or 
rickety children than in others. Sometimes there is 
only one paroxysm, such as has been described, com- 
ing on suddenly, and usually at night. Sometimes 
there are several, at periods of a few hours, days, 
weeks, or even months. In the intervals, the child is 
apparently well. There is danger of death from suf- 



SPASM OF THE THROAT. 



79 



focation during any of these paroxysms, but this 
occurrence is not very frequent. 

If a child should be suddenly roused from sleep 
with great difficulty of getting breath, cold water 
should be dashed upon the face and chest, its body 
be exposed to the cool air, and the surface slapped to 
excite respiration by reflex action to " bring it to," 
as it is called. Hartshorn, if at hand, or strong 
water of ammonia may be held near, but not too near, 
to the nose. A good plan is to dip a couple of fingers 
in the fluid and move them about at a distance of 
half an inch or so from the nostrils. If the spasm 
does not relax almost immediately, the forefinger 
should be passed down the child's throat, to try to 
force an entrance into the air-passage, or to pass 
beyond any obstruction which may be felt. This is 
usually all that there is time or opportunity for doing 
during a first paroxysm. Warm water should be kept 
at hand in apprehension of subsequent paroxysms, so 
as to place the body of the child in a warm bath while 
the neck and face are being bathed with cold water. 
Meanwhile the services of the physician should be 
solicited for advice as to the general treatment of the 
case, and the proper method to be pursued in case of 
a repetition of the spasm. 

Spasmodic Cough, due to uncontrollable approxi- 
mation and separation of the vocal cords, sometimes 
occurs, usually in excitable and hysterical individuals, 



80 THE THROAT AND THE VOICE. 

chiefly females. It has been likened to St. Vitus's 
dance, as that disease affects the limbs, and certainly 
accompanies a few cases of that affection. The cough 
is characterized by frequent repetitions of some pecu- 
liar sound, incessant almost, for the time being, and 
imitative of the cry of some of the lower animals ; 
that of the yelp of a little dog being by far the most 
frequent sound. Sometimes it is like the quack of a 
duck, and so on. The sound is sometimes repeated 
as often as every second, during a minute or two, to 
be resumed after a brief pause of five or more minutes. 
Any excitement usually brings on the cough. It does 
not cease even during meals, in some cases. It does 
not occur during sleep. The affection is often of 
long continuance, even for months or years, and is 
sometimes very distressing. It is not commonly due 
to any disease in the throat or windpipe itself, but 
usually to some irritation elsewhere. It is essential, 
therefore, in the treatment of this affection, that the 
individual submit to whatever treatment the physician 
considers appropriate to restore the equilibrium of 
general health, even though the organ treated be far 
away from the throat, and without any direct con- 
nection with it. Electricity suitably applied, so as to 
subdue the irritability of the great nerves that course 
along the neck, will often promptly control the cough ; 
but the cure is not apt to be permanent unless the cause 
of the reflex irritation be removed. 



SPASM OF THE THROAT. 



81 



Ear Cough. — A variety of spasmodic cough is act- 
ually due to irritation in the ear, probably conveyed 
along a nerve that runs on the inside of the drum 
membrane of the ear. It is less intense than the 
spasmodic cough just described, and can be excited 
by placing the finger or some other object in the ear. 

It is to be cured by treatment directed to the ear, 
and not to the throat. 

Spasm of the Pharynx, or entrance into the gul- 
let, sometimes occurs, especially in hysterical subjects. 
Here there is an inability to swallow, the sensation 
being as though there were some mechanical obstruc- 
tion to the passage of the food. There is great fear, 
in the mind of the individual, lest food and drink 
should go the wrong way, i. e. into the air-passages, 
and produce suffocation. Sometimes there is a spasm 
of the palate, too, with more 01 less constant uneasy 
sensations in the parts. 

These cases require the judicious management of a 
competent medical attendant. 

F 



CHAPTER XIV. 

NEURALGIA OF THE THROAT. 

NEURALGIAS, or pains along the course of the 
nerves, occur in different portions of the throat, 
as they do elsewhere. The absence of evidences of 
serious disease, on the one hand, or the presence of 
tumors and the like pressing on the course of a nerve, 
on the other, indicate the true nature of the com- 
plaint, which is to be treated by the means usual 
in the treatment of neuralgias generally. It is quite 
possible, as in spasm, that the malady is often of 
reflex origin from disease in some distant part of the 
body; and in such instances the neuralgia will not be 
likely to subside permanently until that organ re- 
covers, whether it does so spontaneously, as is some- 
times the case, or as the result of intelligent treatment, 
as is more frequent. 

These neuralgias are not to be confounded with 
the pains incidental to inflammatory and other affec- 
tions of the throat, of which they are symptomatic 
accessories. 

82 



CHAPTER XV. 



NASOPHARYNGEAL CATARRH. 



THE upper portion of the pharynx, above the 
palate, the roof of the pharynx, and the pos- 
terior portions of the nasal passages are liable to 
become diseased together in the form of what is 
known as naso-pharyngeal catarrh. It is quite com- 
mon as a chronic affection or disease of long stand- 
ing, and is usually the result of a succession of more 
or less acute attacks which have left the mucous mem- 
branes of the parts designated in a permanently 
swollen condition, with a disposition to excessive 
secretion from their mucous glands. In some cases, 
the glands themselves are diseased and permanently 
enlarged. 

The symptoms are those of more or less continuous 
impediment to free respiration through the nose, and 
the accumulation of viscid phlegm or mucus in the 
upper part of the pharynx, and at the back part of 
the nasal passages. This mucus is usually hawked out 
of the throat by a more or less violent inspiratory 
effort through the nose, attended at times with more 

83 



84 THE THROAT AND THE VOICE. 

or less gagging. Sometimes portions of the mucus, 
which cannot be discharged in this way, become de- 
siccated into crusts, which decompose in the parts and 
give rise to fetid breath, and are discharged, at in- 
tervals of a few days, in masses of variable size, often 
more or less moulded to the shape of the parts from 
which they come. This discharge gives relief to a 
disagreeable sense of stuffiness in the parts, which 
gradually reappears as fresh masses accumulate. These 
masses are sometimes tinged with blood from rupture 
of small vessels. Sometimes these masses are swal- 
lowed, either voluntarily or unwittingly. They should 
always be expectorated. If taken into the stomach, 
they irritate that organ and the intestines, for they 
are insusceptible of digestion, and thus are apt to 
produce dyspepsia and irregular diarrhoea. There is 
no ulceration of the f# diseased tissues, except under 
peculiar conditions of system; a fact which it is well 
to bear in mind, especially if resort is had to adver- 
tising charlatans, who are often disposed to assert the 
existence of ulcerations to make their services appear 
the more valuable in case of cure at their hands. In 
fact, many of these practitioners state that the dis- 
charged masses of desiccated mucus are ulcers which 
have come away. 

The chief point of treatment in this affection is 
to employ whatever means may be necessary to re- 
establish the general health or improve it, and to 



NASO-PHARYNGEAL CATARRH. 85 

cleanse the parts of these masses at regular intervals, 
so as to prevent their accumulation. If this cleansing 
is thorough and efficient, the mucous membrane, freed 
from the mechanical irritation of their presence and 
the chemical irritation of the products of their de- 
composition, will get well of itself. Without the 
cleansing, relief from treatment, local as well as con- 
stitutional, will only be temporary. Under proper 
management, the relief will be permanent. 

There are several methods of cleansing the parts. 
The best material to use, in most instances, is a solu- 
tion of table salt, or of carbonate of sodium, one 
teaspoonful to the quart of tepid water at about blood 
heat. It is necessary to have the fluid at about the 
same temperature and specific gravity of the blood, 
in order to avoid certain injurious effects which may 
otherwise follow. The fluid may be snuffed up from 
the hand or from a cup or other vessel, or be thrown 
into the nasal passages from a syringe or a spray- 
producer, or be passed over the parts in a douche from 
a vessel supplied with flexible tubing and a well-fitting 
nozzle, applied within each nostril alternately. These 
washes should not be applied until their method of 
application is shown and explained by the physician, 
because of a liability that the fluid may run through 
the vent-hole of the drum of the ear into the drum 
itself, and produce serious and sometimes permanent 
injury. The head should be slightly bent forward, 
8 



86 THE THROAT AND THE VOICE. 

the mouth be kept open during the process, and all 
movements of swallowing avoided. With fluids of 
proper temperature and density, these precautions will 
almost always secure the individual from injury, unless 
there is some deformity, congenital or from disease, 
or an unnaturally large orifice to the vent-tube of the 
ear-drum. 

When there is an offensive odor from the retained 
masses of phlegm and mucus, a disinfectant should 
be added to the cleansing solution. These ablutions 
should form an essential part of the daily toilet, as 
much so as a resort to the tooth-brush or the wash- 
basin. 

Cases of naso-pharyngeal catarrh kept up by the 
presence of foreign bodies, tumors in the nasal pas- 
sages or dead bone, will not get well until after the 
removal of these sources of irritation. 



PART II. 
THE VOICE. 



CHAPTER I. 



VOICE. 



THE VOICE is the sound generated in the larynx 
at the upper part of the air-passage, by the rapid 
vibration of the edges of two membranous bands, 
stretched transversely over the top of the windpipe, 
from before backward and slightly 

downward. A delicate elliptic space r ! ff " " ' ia gram 
. , „ , . , , . of the Vocal Bands 

is left between the two vocal bands as Adjusted for Pho . 

(Fig. V.); and the air from the lungs, na tion, or Voice, 
as it escapes forcibly through this 
contracted passage, strikes the edges 
of these bands with a force which 
sets them vibrating. The sound 
started in the air-tube by this vibra- 
tion is the voice. During ordinary 
respiration, these vocal bands are 
widely separated behind, so as to present a large tri- 
anguloid space between their edges for the uninter- 

87 



Vocal Bands. 



88 THE THROAT AXD THE VOICE. 

rupted and free passage of the air (Fig. VI. ); and they 

separate a little more during a deep inspiration, and 

move slightly towards each other during expiration. 

In sounding the voice, how- 
Fig. VI.— Diagram of the , , ^ 

v . „ , e . , ^ ever, as above stated, the 

Vocal Bands Separated Be- 

hind, as in Ordinary Breath- vocal bands are brought to- 

ing. gether posteriorly to the 

/^X middle line, and held there 

/M^^\ as l° n £ as tne sound is being 

( A ^J"\ made (Fig. V. .separating 

( M& 3^ ) again when a deep inspira- 

^is^^^J^ tion is to be made (Fig. \ 

1 for the'Bre^" "" *"* ***" the P rocess bein S repeated as 

long as vocalization is con- 
tinued. It is thus that the ordinary expiratory cur- 
rent of breathing is utilized in the normal production 
ol the voice. A vocal sound can be produced by the 
inspiratory current likewise, if a special effort is made 
to do so. as sometimes practised by ventriloquists; but 
the sound is rough, coarse, and disagreeable, and the 
effort soon becomes tiresome and difficult. 

In cases of spasmodic approximation of the vocal 
bands, as occurs in certain cases of false or spasmodic 
croup, and in a number of diseases of the upper por- 
tion oi the air-passage, this unnatural vocal sound is 
actually produced at every forcible effort of inspira- 
tion, and constitutes a special alarming and heart- 
rending sound which is known as stridor. 



CHAPTER II. 

ACOUSTICS OF VOICE. 

THE physical laws in accordance with which voice 
is produced are just the same as those which 
control the physical production of all other sounds. 
If, therefore, the general laws of sound (acoustics) 
are reviewed, and then the mechanism of those por- 
tions of the human organism concerned in the pro- 
duction of vocal sound is studied afterward, consid- 
erable insight will be gained as to the nature of the 
voice. 

What is sound? "Something we hear," some 
bright little reader may mentally reply. And so it is, — 
something that is heard. And it is only by hearing 
it, that it can be comprehended. The deaf-mute has 
no conception of the nature of sounds. If he were 
standing alone by the Falls of Niagara, there would 
be no sound, for there would be no organ of hearing 
to interpret as sound the commotion in the water and 
in the atmosphere produced by the great cataract. 

The sensation of sound is due to a certain motion 
or tremor produced in the molecules of the extreme 
8* 89 



88 THE THROAT AND THE VOICE. 

rupted and free passage of the air (Fig. VI.); and they 

separate a little more during a deep inspiration, and 

move slightly towards each other during expiration. 

In sounding the voice, how- 
Fig. VI.— Diagram of the , . , ., 
« *« j « ^ t> ever, as above stated, the 
Vocal Bands Separated Be- 

hind, as in Ordinary Breath- vocal bands are brought to- 

ing. gether posteriorly to the 

/^\ middle line, and held there 

/ ^hBL\ as long as the sound is being 

I ML w^l\ ma d e (Fig. V.); separating 

\Jk Ilk ' again when a deep inspira- 

^^^B^S^ tion is to be made (Fig. VI.); 

"" for Xe'Brfa^ 5 ' "" *** ^^ the P rocess bein 8 repeated as 

long as vocalization is con- 
tinued. It is thus that the ordinary expiratory cur- 
rent of breathing is utilized in the normal production 
of the voice. A vocal sound can be produced by the 
inspiratory current likewise, if a special effort is made 
to do so, as sometimes practised by ventriloquists; but 
the sound is rough, coarse, and disagreeable, and the 
effort soon becomes tiresome and difficult. 

In cases of spasmodic approximation of the vocal 
bands, as occurs in certain cases of false or spasmodic 
croup, and in a number of diseases of the upper por- 
tion of the air-passage, this unnatural vocal sound is 
actually produced at every forcible effort of inspira- 
tion, and constitutes a special alarming and heart- 
rending sound which is known as stridor. 



CHAPTER II. 



ACOUSTICS OF VOICE. 

THE physical laws in accordance with which voice 
is produced are just the same as those which 
control the physical production of all other sounds. 
If, therefore, the general laws of sound (acoustics) 
are reviewed, and then the mechanism of those por- 
tions of the human organism concerned in the pro- 
duction of vocal sound is studied afterward, consid- 
erable insight will be gained as to the nature of the 
voice. 

What is sound? "Something we hear/' some 
bright little reader may mentally reply. And so it is, — 
something that is heard. And it is only by hearing 
it, that it can be comprehended. The deaf-mute has 
no conception of the nature of sounds. If he were 
standing alone by the Falls of Niagara, there would 
be no sound, for there would be no organ of hearing 
to interpret as sound the commotion in the water and 
in the atmosphere produced by the great cataract. 

The sensation of sound is due to a certain motion 
or tremor produced in the molecules of the extreme 
8* 89 



gO THE THROAT AND THE VOICE. 

filaments of the nerve of hearing, and vibrating syn- 
chronously or in unison with the sonorous body. The 
motions of the sounding body are transmitted in 
pulses or waves through the air, or whatever other 
medium it may be, into our ears, and thence along 
the nerve of hearing into the brain, by which it is 
perceived and interpreted, and upon which it makes 
the special impression which we designate sound. 
Now, whether this motion is communicated from 
without, as in the ordinary sounds to which we are 
daily accustomed, or whether it exists primarily in 
the filaments of the nerve of hearing, the result, in 
either case, is sound. A blow upon the side of the 
head often shakes the auditory filaments and produces 
sound. A current of electricity passed through the 
organ of hearing likewise produces sound. There is 
reason to believe that the singing in the ears occa- 
sionally heard by nearly every one, and the noises of 
wind and water, sometimes of music, and so on, to 
which certain invalids are subject, are all of them the 
result of a physical motion or tremor set up in the 
auditory apparatus. 

The peculiar form of motion which gives rise to 
the sensation of sound is that form known as oscilla- 
tion or vibration ; a motion that repeats itself at reg- 
ular intervals, — a motion to and fro, up and down, 
forward and backward, — the motion of a pendulum, 
of the balance-wheel of a watch, of the strokes of a 



ACOUSTICS OF VOICE. 



91 



trip-hammer, of a ball kept tossing in the air, etc. 
The effect upon the air is to produce alternate con- 
densation and rarefaction in spherical waves or undu- 
lations, radiating from the centre of disturbance. 
When this sort of motion is not excessively rapid, 
that is to say, when it recurs with less frequency than 
sixteen repetitions in the second of time, it is too 
sluggish to rouse the organ of hearing, and produces 
merely some of the ordinary manifestations of me- 
chanic force, as we see in the industrial arts. But 
when it is more frequent than sixteen times per sec- 
ond, there is special manifestation of sound, what- 
ever the physical work that may be going on ; and 
the pitch, intonation, or acuteness of the sound rises 
in direct proportion to the increased frequency of the 
motion,* until, at the rate of from thirty thousand to 
forty thousand repetitions per second, the effect be- 
comes so shrill and sharp as gradually to transcend 
human powers of hearing it ; when all sound ceases, and 
our ears are silent to the increased motion. There is 
abundant evidence, however, to show that vibrations 
even still more rapid can be heard by insects and 
other animals. The physical reason that such rapid 
vibrations fail to impress the organ of hearing, is 
probably due to the fact that they are too rapid for 
the weight or density of the nerve-fibres to respond 

* Listen to the musical whiz of a steam-saw when sawing 
lumber, for example. 



92 THE THROAT AND THE VOICE. 

to, and that before these fibres have time to recover, 
as it were, from the forward motion of one oscillation, 
the others come on behind with such rapidity as to 
keep the nerve-fibre pressed still, or dampened, as it 
were, so that it has no opportunity to vibrate, and is 
consequently silent. 

Away beyond the limits of audition, among vibra- 
tions the rapidity of which we cannot realize, amount- 
ing to tens of millions per second, the special physical 
manifestation is perceived as electricity \ and far be- 
yond the limits of electric excitation, where the motion 
begins to be executed in hundred of millions of vibra- 
tions per second, the manifestation of the motion is 
heat ; and when the frequency of vibration amounts 
to several hundreds of millions per second, the mani- 
festation is light ; and beyond the limits of light, the 
motions produce those still occult forces of decom- 
position and recomposition known as chemical action. 
Hence, chemical action, light, heat, electricity, sound, 
and mechanic force are all manifestations of one uni- 
versal force — motion. As these manifestations are to 
a certain extent convertible one into another, we are 
led to the comprehension of a grand fundamental 
principle of science known as the correlation of 
forces. 

Strike a match, — one of the most wonderful inven- 
tions of human ingenuity, by the way, — and you may 
demonstrate several of these points at one stroke ; a trite 



ACOUSTICS OF VOICE. 



93 



experiment, it is true, but striking and brilliant, both 
literally and intellectually. The friction — mechanic 
force — develops a rapid vibration of the air around 
the head of the match, producing one kind of sound, 
while the explosion produces another ; heat is com- 
municated to the wood of the body of the match, 
which becomes warm to the fingers that hold it ; light 
is produced by the explosion and subsequent ignition 
of the match, and the wood burns ; and chemical ac- 
tion results, as evinced by the cloud of phosphoric 
acid, and the oxidation of the hydro-carbon of the 
burning wood ; while, furthermore, the presence of 
electricity, always generated in chemical action, might 
be demonstrated were an electroscope or electrometer 
in proper connection with the match. Here, then, we 
have a variety of motions excited, illustrating the 
entire series of forces. 

Rapid vibrations (at a rate exceeding sixteen per 
second), then, produce a peculiar effect, which excites 
that special sensation which is termed sound. At this 
rate of sixteen vibrations per second, the sound is a 
low rumble, which almost admits of perception of the 
coalescence of the sixteen vibrations into a deep tone, 
as in the sound from the longest organ-pipe, excep- 
tionally used in very large organs, which is thirty-two 
feet in length, and gives the C* of i6J vibrations per 
second. 

The more rapid the vibrations, the higher in pitch 



94 THE THROAT AND THE VOICE, 

becomes the sound, until a rapidity of motion is ac- 
quired which the ear fails any longer to appreciate ; 
this limit varying in individuals according to the 
sensitiveness of their hearing apparatus. When these 
vibrations are- equal-timed, — isochronous (isos, equal; 
chronos, time), periodic or rhythmic, — the effect of the 
sound is pleasant, and termed musical. When they 
are irregular or unperiodic, the effect upon the ear is 
unpleasant and disagreeable, analogous to the optical 
effect from an irregularly flickering flame, and the 
sounds that result are termed noisy. Music and noise, 
therefore, are similar in their physical qualities ; and 
they present points of mutual approximation, although 
their extremes differ greatly. 

The limits of noise and of music, respectively, 
depend solely upon the degree of pleasurable or dis- 
pleasurable sensation produced upon the hearer, and 
vary, therefore, in different individuals, according 
to the delicacy or sensitiveness of their auditory 
nerves. 

Music, the result of rhythmic or equal-timed vibra- 
tions, is audible at greater distances than noise, the 
result of irregular or unequal-timed vibrations. This 
greater reach of music is intuitively utilized in the 
street cries* of large cities, in the auctioneer's rattle- 

* Such as those of the rag-men, venders of fish, fruit, hot-corn, 
etc. Philadelphians will recall the great reach of the peculiar, 
musical cry oi' the "hominy man." 



ACOUSTICS OF VOICE. 95 

like announcement of bids at a public sale, in calling 
out to persons at a distance, and the like. 

Music and noise are convertible, also. Sounds 
which in themselves are musical, as the successive 
tones of the gamut rapidly produced from the piano- 
forte, for example, become discordantly transmuted 
into noise if struck together simultaneously. When 
this is done, the rhythmic vibrations of each string 
conflict in part, and thus excite irregular move- 
ments. 

On the other hand, again, sounds which are simply 
noises as long as they remain isolated, such, for ex- 
ample, as sounds produced by striking a piece of 
wood, or a paving-stone, may be transmuted into 
music by striking them in series arranged to yield the 
tones of the gamut, as in the xylophone, or wood 
piano, the glass harmonicon, and similar instruments. 
The musical character of the tones evolved by the 
rammers of the street-pavers when a series of them 
are engaged in hammering the cobble-stones of our 
streets, is well known to residents of cities. It is on 
record that a series of animals have been utilized as 
musical instruments. Thus, we read that at Brussels, 
in 1549, during a celebration in honor of a miraculous 
image of the Virgin, a bear performed upon an organ 
of cats. This organ was composed of twenty live cats — 
with cries giving consecutively the tones of the gamut — 
confined separately in narrow boxes, over which their 



g6 THE THROAT AND THE VOICE. 

tails passed ; these appendages being secured to cords 
which were fastened to the registers of the organ, and 
corresponding to the keys of the instrument. Each 
time that the bear struck his paw upon a key, he 
thereby pulled on the tail of one of the unfortunate 
prisoners, and thus forced the series to miau through 
the whole gamut. Conrad van der Rosen, the jester of 
the Emperor Sigismond, is said to have succeeded in 
curing his master of a black melancholy, by executing 
melodies upon an organ of cats, ranged in gamuts, 
whose tails he pinched in striking the keys. As sen- 
tentiously observed by Radau, from whose volume on 
Acoustics the above anecdotes have been taken, 
" Cats were not happy at this epoch." 

Sounds, vocal and otherwise, differ in three impor- 
tant characteristics — intensify, pitch, and qualify. 
Attention may be called, in addition, to a subdivision 
of quality, especially as regards the voice, — reach or 
penetrant power over distances. 

Intensity means loudness, and is independent of 
pitch or quality. Pitch is the degree of acuteness 
or gravity, the intonation, or the position of the sound 
in the musical scale, and is independent of intensity 
or quality. Quality {timbre, tone-character) is that 
peculiarity by which the sound of any one instrument 
or one voice is distinguished from other instruments 
or other voices, and is independent of intensity or 
pitch. 



ACOUSTICS OF VOICE. 



97 



Intensity. — Intensity is due to the extent of the 
vibration to and fro, consequently to the size of the 
sound-waves or undulations, set up in the atmosphere. 
Now, bodies vibrating in larger excursion to and fro 
from their point of rest, set larger masses of air in 
motion than when that excursion is more limited ; 
and the greater the extent to which the disturbance 
in the air — really a condensation and rarefaction — ■ 
reaches, the louder the sound. If we pull lightly 
upon the cord of a piano, it will vibrate but a short 
distance to and fro, and the sound will be feeble ; 
but if we pull it more forcibly, it will move over a 
greater space, and the sound will be louder because a 
greater mass of air is set in motion, and larger waves 
of sound generated in consequence. The same thing 
takes place in the human voice. If the vocal cords 
(as they are unfortunately called, for they are not 
cords but bands) are only moderately tense, they can 
move over a larger extent of space than when they 
are held more tense. Hence the sound is louder, 
and the sound-waves being larger, they are felt, in 
certain portions of the scale, as they strike the walls 
of the windpipe, bronchial tubes, and air-cells of the 
lungs, — for sound-waves travel spherically in every 
direction from the point of disturbance — producing 
that peculiar vibration of the chest-walls which has 
given rise to the denomination of chest-tones in the 
lower portion of the vocal register. The intensity 
9 G 



98 THE THROAT AND THE VOICE. 

of the voice depends upon the force of impact of 
the escaping current of air, and upon the elasticity of 
the vocal bands. 

Pitch. — The range of sound of which the human 
voice is capable — its compass — consists in round 
numbers of from two and a half to three octaves ; less 
than that in most voices, more in some rare instances ; 
the entire range, taking male and female voices to- 
gether, being about five octaves. The extreme limits 
of human voice observed, however, are said to be 
the F 1 of 43J vibrations per second, in the voice of 



^ 



Fisher, ■ ~J — , to the c 6 of 2100 vibrations in 

the voice of La Bastardella, Q \ ~- — . Now, for 



i 



the production of every note in the register of a voice, 
there is but a short pipe, the windpipe, the length of 
which, by the elevation of the larynx as the sounds 
rise in pitch, can be so slightly varied as to count for 
little in the mechanism, and a pair of elastic mem- 
branous bands (reeds, tongues, vocal cords), each less 
than an inch long and less than a quarter of an inch 
broad, and with but one free surface or edge. The 
modification of pitch is chiefly effected by progressive 
variations in the tension of the membranous vocal 



ACOUSTICS OF VOICE. 99 

bands, and by slight variations in the shape of the 
elliptic fissure between them ; a number of complex 
muscular actions being concerned in bringing this 
about. This is supplemented by variations in the 
position and shape of the walls of the larynx and 
windpipe, pharynx and mouth ; but to what extent, or 
in what manner, is as yet undetermined. The force 
of the current of air will likewise affect the pitch to a 
certain extent, as in wind instruments generally. 

It is known that if a violin string or a drum-head 
be stretched, so that its tension is increased, the sound 
it will yield when struck will be higher in the scale 
the greater the tension ; while the pitch falls as the 
string or membrane is slackened, because its tension 
is being decreased. So it is with the human voice. 
When the laryngeal muscles stretch the vocal cords, 
increasing their tension, the pitch ascends; and when 
the muscles are relaxed so that the tension is dimin- 
ished, the pitch falls. It is likewise known that if a 
string or membrane is slackened too much, it will not 
vibrate at all, and will yield no sound ; and if stretched 
too much, it will be ruptured and become incapable of 
sound until readjusted or repaired. Mere stretching 
of the vocal bands, being practicable only within 
moderate limits, will only increase the pitch to a cer- 
tain extent ; and for the further extension of the reg- 
ister, another action of the muscles is requisite, which 
progressively shortens the free surfaces of the cords 



100 THE THROAT AND THE VOICE. 

at the same time that they are rendered tense. If we 
examine the strings yielding the higher tones of a 
piano, we see that they are shorter and shorter as 
these tones rise in the scale; and we know that if the 
length of a string on the violin is practically shortened 
by placing a finger on it, stopping it, its tone rises in 
pitch, and that the shorter the string the acuter is the 
sound. Thus it is apparent that the processes in the 
human organ, stretching and shortening of the vocal 
bands, are the same physically as those employed in 
artificial musical instruments for raising the pitch. 
The pitch of a sound, as has been said, depends on 
the number of vibrations that the generator of the 
sound sets up in the air in a given time — the greater 
the number of vibrations per second, the higher the 
pitch ; and it is evident, on a moment's thought, that 
the shorter anything is, the more rapidly it can be 
moved, and that the tenser it is the more rapidly it 
can be moved. The physical laws that preside over 
the production of the human voice do not differ in 
any particular from the physical laws governing the 
production of sound from any other source. 

Quality. — It is a point of universal observation 
that of several notes of the same pitch and of equal 
intensity, one may be distinguished as coming from 9. 
harp, another from a violin, a third from a flute, a 
fourth from a human voice, and so on. A musical 
ear will distinguish one flute from another, one violin 



ACOUSTICS OF VOICE. 



101 



from another, one voice from another. Nay, more ; 
it will distinguish the peculiarity of different per- 
formers of equal skill upon the same identical instru- 
ment, the peculiar ring of the same voice as it is at its 
be-.t or otherwise. This difference is quality, or timbre. 
It is that characteristic by means of which we distin- 
guish the voices of our friends, whom we can thus 
recognize in the dark, or under a change of feature, 
or of dress after long separation. The physical cause 
of quality is difficult of comprehension. It has so 
important a bearing upon the cultivation of the voice, 
that an attempt must be made to explain it, even in 
a little popular volume like this. The quality of a 
tone depends, physically, upon the shape or com- 
posite conformation of the series of undulatory waves 
of sound which collectively produce it. Variation in 
the shapes of sound-waves of like pitch and intensity, 
or of varying pitch and intensity too, for that matter, 
depends upon the fact that all sounds are composite. 
Indeed, they are susceptible of being analyzed exper- 
imentally into their component factors, by shutting 
off the appreciation of portions of the series, on a 
principle analagous to that by which a ray of white 
light may be decomposed into the prismatic colors 
*f the spectrum. 

In any sound, as that from one note on the piano 
or violin, there is a fundamental or ground-tone, 
which determines the pitch, — that tone which strikes 
9* 



102 THE THROAT AND THE VOICE. 

our attention prominently. If we listen attentively, 
however, knowing beforehand what we are to try to 
detect, we find, commingling with it, other and 
feebler sounds which are higher in pitch,* and which 
bear to it certain simple relations of harmony, f 
Where the harmony of these additional tones — 
1 ' upper-tones " or ' ' over-tones, ' ' as they are termed — 
is perfect, the effect is very agreeable ; and where 
there is an element of discord, the sound is less 
pleasant. If we listen to the striking of a bell, such 
as is used in a town-clock, for example, we shall be 
able to detect some of these sounds, especially as the 
ground-tone of the bell is fading. J But they exist in 
all other sounds likewise. They may readily be de- 
tected in the graver tones of the piano. It is the 
relations which these over-tones bear to the funda- 
mental tones, different in different instruments and 
voices, and dependent in great measure on the shape 
and character of the instrument and vocal apparatus, 

* Some are lower, also, and the two sets produce new com- 
binations of summation-tones and difference-tones ; but these are 
not alluded to in the text, for fear of rendering the elucidation 
too complex for most of the readers of a scientific primer. 

f These comprise the octave above, the 5th of that octave, the 
second octave, the major 3d of that octave, etc., being due to 
vibrations of 2, 3, 4, 5, etc., times as many as the fundamental 
tone. 

J A globe such as is placed over a gas-jet gives the same re- 
sults when struck. 



ACOUSTICS OF VOICE. 



I03 



which decides the timbre. Each over-tone makes its 
own impress on the air, as well as the fundamental 
tone does ; and the shape or form of the vibration is 
made up of the combined effect. Take these over- 
tones away from the fundamental tone, or conceal 
them, as can be done by certain experiments, and the 
fundamental tone of every instrument has exactly the 
same quality. These over- tones are less prominent in 
large open organ-pipes than in any other instruments 
of music ; and that is the reason why their sounds are 
dull and unsatisfactory to the ear.* The organ-builder 
is aware of the fact that the sounds of large organ-pipes 
are unsatisfactory, though he may not be aware of the 
reason; and he has found out empirically — by expe- 
rimental investigation — that the defect can be rem- 
edied by adding a series of pipes of higher pitch, 
giving the harmonics, as they are termed. And these 
additional pipes are so arranged that they are all 
opened simultaneously with the fundamental pipe, so 
that they all sound together and enrich and reinforce 
the dull or pitch pipe. This arrangement is called 
a furniture. In fact, it furnishes the very upper-tones 
which are deficient in the tone of the large pipe ; and 
when the entire series are sounded together, the com- 
bined quality satisfies the ear. 

* An idea of what is meant can be obtained by blowing over 
a bottle. The over-tones are weak, and the pitch appears graver 
than it really is. 



104 THE THROAT AND THE VOICE. 

Quality or timbre, then, results from the harmonious 
commixture of a fundamental or ground-tone and 
its over-tones and their combinations. The delicacy 
or shade of the clang of the tone varies with the 
number of these over-tones, their position in the 
musical scale, and their relative intensity as main- 
tained during the continuance of the tone. The 
clang is an accord, a sort of orchestral combination 
in miniature. 

The ground -tone of a tuning-fork, as the easiest 
example to be cited, may be isolated from its over- 
tones by causing it to vibrate over a rather wide bot- 
tle, resonance-tube, or box, the deepest tone of which 
corresponds in pitch to that of the fork. As the 
higher tones of the fork differ from the higher tones 
of the resonance tube, the ground- tone alone becomes 
intensified, and the over-tones of both are unheard. 
The mixture of the two ground- tones then results in 
a simple tone, to all intents and purposes. 

With this explanation, it is hoped that the reader 
can understand that any influence which interferes 
with the precision with which both vocal bands should 
be adjusted, in equal strain and tension, will disturb 
the harmony of the fundamental and upper- tones of 
either band, or both of them, and thus impair the 
quality of the voice. This precision of equable ad- 
justment is really greater in a well-trained voice than 
that acquired in playing upon any artificial instrument 



ACOUSTICS OF VOICE. 



I05 



of music, and is the main reason of the superiority of 
execution acquired by a skilled vocalist over that of 
an instrumental performer. The automatic control 
of adjustment attained by Madame Mara, whose voice 
had a compass of three octaves, is said to have been 
such that she could effect as many as twenty-one hun- 
dred changes in pitch, 100 between each two notes of 
the 21 in her compass. The ordinary capacity of a 
voice in good culture is stated to be equal to about 
two hundred and fifty changes, ten or more for each 
tone of a compass of two octaves, or a little beyond. 
As each change in the tension of the vocal bands 
would not vary their length more than the one-fif- 
teen-hundredth part of an inch, we can faintly estimate 
the extreme delicacy of adjustment of tension of which 
the muscular apparatus of the vocal organ is suscep- 
tible ; a delicacy greatly in excess of that acquired 
in the trained fingers of the most skilled workman. 
In Madame Mara's case, the variations of tension be- 
tween the tones that she could produce would repre- 
sent a successive lengthening and shortening of the 
vibrating edges of her vocal bands in successive pro- 
portions of one-seventeen -thousandth of an inch, — 
a marvellous and almost inconceivable delicacy of 
precision of touch. 

The capabilities of well - cultivated phenomenal 
voices are almost incredible. Thus, among a number 
of instances alluded to by Mrs. Seiler in her excellent 



I06 THE THROAT AND THE VOICE. 

manual on " The Voice in Singing," it is related of 
Farinelli, among other things, that " on one occasion 
he competed with a trumpeter, who accompanied him 
in an aria. After both had several times dwelt on 
notes in which each sought to excel the other in 
power and duration, they prolonged a note with a 
double trill in thirds, which they continued until both 
seemed to be exhausted. At last the trumpeter gave 
up, entirely out of breath ; while Farinelli, without 
taking breath, prolonged the note with renewed 
volume of sound, trilling, and ending, finally, with 
the most difficult of roulades." 

Reach is the penetrant power of a sound over dis- 
tance and obstacles, such as other sounds, and is due 
to the purity of the tone, which, in its turn, is de- 
pendent on the accuracy with which it is produced. 
It is well known that at the great musical Peace Jubilee 
at Boston, in 1869, the pure tones of the voice of 
Madame Parepa-Rosa were distinguishable above the 
accompaniment of a chorus numbering nearly twelve 
thousand voices, and an orchestra of more than one 
thousand instruments; and this with audiences esti- 
mated at over 40,000 people. A voice, the tones of 
which are accurately poised, will travel a great dis- 
tance, independently of its intensity or loudness; and 
this accounts for the remarkable facility with which 
some people are heard, even with relatively feeble 
voices. 



ACOUSTICS OF VOICE. 



I07 



The quality of the voice, due, as we have seen (page 
io4\ to the harmonious relation between the funda- 
mental tone of the vocal bands and its upper-tones 
or harmonics, is largely dependent upon the reso- 
nance of the cavities of the throat, mouth and nose, 
through which the expiratory current of air passes 
out, and the waves of sound likewise, after the vocal 
bands have been set into vibration. The vocal bands 
are the generators of tone ; but if the waves set up 
were not reinforced by the cavities above, the sound 
would be much like that of the reeds of mechanical 
toys. This is observed in individuals who have cut 
their throats in such a manner as to expose the vocal 
bands to direct inspection. The air, and the sound- 
waves escaping by the wound in these cases, have not 
that peculiar resonance imparted to them which they re- 
ceived when they passed through the natural passages ; 
and thus the peculiar or familiar vocal sound is not 
produced . When the tonsils are enlarged, as in quinsy, 
for example, this peculiar resonance is impaired, and 
the voice acquires a characteristic dull and disagree- 
able timbre or quality, which disappears when the 
parts resume their normal dimensions. So, too, when 
the nasal passages are occluded ; whether by design, 
accident, or disease. The influence of loss of teeth 
on the quality of the voice is well known, and the 
change is easily apparent when a set of false teeth is 
removed from the mouth, or used for the first time. 



108 THE THROAT AND THE VOICE. 

It may be mentioned, here, that the prejudice, exist- 
ing to a certain extent among vocalists, against re- 
moving the exuberant portions of chronically enlarged 
tonsils, for fear of impairing the voice, is a chimerical 
one ; the fact being the reverse. Clipping off the 
excess of a permanently elongated uvula, likewise, 
far from injuring the voice, occasionally improves it, 
though there is usually no effect noticeable. The irri- 
tation excited by leaving it undipped, on the other 
hand, may impair the voice considerably. 

When the cavity resounds to the fundamental note of 
the vocal bands, or to one of its higher harmonics or 
over-tones, the sound is reinforced in a peculiar man- 
ner. The interior of the throat, mouth, and nose is 
to the vocal bands what the case of the violin is to 
its strings, the sounding-board of the piano to its 
strings, the body of a reed instrument to the reed, 
and so on. The sounds of the strings and reeds in 
unison with the sound yielded by striking the case, 
sounding-board, or pipe, or in unison with their over- 
tones, are those most strongly reinforced. So, too, 
with the voice. The sounds of the vocal bands in ac- 
cord with the sound proper to the shape of the reso- 
nant cavity of mouth and throat at the moment are 
those which are most reinforced ; and as the proper 
sound of the resonant cavity of the voice varies with 
its shape, so, for the time being, the sounds vary which 
it can reinforce at the moment. If a series of fillips 



ACOUSTICS OF VOICE. 



IO9 



are given to the cheek with the finger, while the 
mouth is opened wider and wider, a different pitch 
will be given to each sound produced. The trick of 
imitating the flow of liquid from a bottle in this 
manner is a familiar instance. The pitch at any given 
moment of the experiment is the pitch of sound of 
the vocal bands which will be most reinforced by that 
position of the mouth. The motions of the mouth, 
tongue, palate, and throat vary the shape of the cavity, 
and its capacity of resonance, for different portions 
of the scale. This fact explains the impossibility of 
making certain sounds of certain pitch, unless the 
mouth and its contents are maintained in a suitable 
position attuned to that pitch. 

The influence of the pitch of a sound in exciting 
a silent instrument attuned to the same pitch is well 
known to musicians. The response of a glass gas- 
globe to certain tones of the voice, for example, or 
the rattling of a pane of glass from a similar cause, must 
be familiar to all. The waves of sound set up in the 
first instance are powerful enough to start the vibration 
of the responding body. The effect is mechanical 
altogether. It is similar to the effect of rhythmic vi- 
bration of a suspended bridge which may accumulate 
force enough to throw it down. Hence marching in 
time is prohibited upon suspension bridges. There is 
an old saying that a bridge of this kind could be de- 
stroyed by continuous fiddling on a note of the same 
10 



IIO THE THROAT AND THE VOICE. 

pitch as that of the bridge, from mere accumula- 
tion of force in the sonorous waves. Heavy bells are 
started by commencing with gentle impulses in rhyth- 
mic accord with the proper oscillation of the bell. 
To quote from an excellent novel (Middlemarch, 
Chap. XXX.): 

" How will you know the pitch of that great bell 
Too large for you to stir? Let but a flute 
Play 'neath the fine-mixed metal ! Listen close 
Till the right note flows forth, a silvery rill: 
Then shall the huge bell tremble — then the mass 
With myriad waves concurrent shall respond 
In low, soft unison." 

The shape of the resonant apparatus (cavities of the 
throat, mouth, and nasal passages), therefore, has 
great influence on the quality of the voice. Altera- 
tions of configuration by disease impair the voice, 
and alterations of shape by design modify it. The 
peculiar vowel sounds of spoken language are found 
to be due to the shape given to the resonant cavity 
in their emission. Thus, with the mouth wide open, 
the only sound that can be made by the vocal bands 
alone, is the vowel sound ah (or #, as in father) ; and 
as the mouth is gradually closed up more and more in 
front, it becomes possible to make the vowel sounds e 
(or a, as in rftzte), i (or e, as in m<?te), o, u or oo, and 
the compound vowel sounds nearest to each pure 
vowel sound respectively. There are also modifica- 



ACOUSTICS OF VOICE. 



Ill 



tions in the position of the tongue and of the soft 
palate which favor the emission of these sounds; but 
it is beyond the purpose of this little volume to do 
more than call attention to the fact that the difference 
between the vowel sounds of a language is chiefly one 
of quality or timbre, the vocal bands or factors being 
merely the exciters of the sounds. A few experi- 
ments before a looking-glass, with the finger in the 
mouth, upon the tongue, or against the palate, will 
teach any one the positions assumed by the tongue, 
palate, and lips in the production of these sounds ; 
and the change made in the character of the vowel 
by altering the shape of the mouth while sustaining 
any sound made by the vocal bands, is readily de- 
tected. The differences between the vowel sounds 
of different languages, or of the same language as 
spoken in different localities (dialects), are due to the 
difference impressed on the shape of the resonant 
cavity, chiefly of the mouth ; and the habit of pro- 
ducing vowels in a certain manner is so strong that 
adults, even with correct ears for musical intonation, 
are unable to screw their mouths up, so to speak, in 
such a manner as to produce the vowel sounds of a 
foreign language accurately ; hence, the broken Eng- 
lish of foreigners, or the permanence of foreign ac- 
cent. Children, on the other hand, whose organs 
are flexible, and have not become too much habituated 
to the special accents of their mother-tongue, acquire 



Il„ THE THROAT AND THE VOICE. 

greater facility in a foreign language, so that, often, 
very little of their original accent is apparent in speak- 
ing the newly-acquired language. The children of 
foreigners in this country, who habitually speak the 
language of their parents in their homes, rarely acquire 
an English accent absolutely free from foreign tinge. 

So important is it deemed by some teachers of vocal 
art, that proper positions of the mouth should be 
maintained for certain sounds, that they actually make 
their pupils practise before a mirror until they become 
expert, or have learned to break themselves of adopt- 
ing awkward positions of the mouth and its contents, 
which impair the purity of the tone, or attract atten- 
tion as contortions or actual deformities. 

It is thus evident that the human vocal apparatus — 
lungs, windpipe, larynx, mouth, throat, and nose — is 
a musical instrument, capable of rendering shades of 
expression far more delicate than any that can ema- 
nate from a musical instrument "the work of men's 
hands." It is emphatically a reed instrument, with 
bellows (lungs), pipe (windpipe), reed-box (larynx), 
two flexible reeds (vocal bands), and resonance at- 
tachment (throat, mouth, nose). These parts are 
movable upon themselves and their adjacent struct- 
ures ; and are kept moist and flexible by a bland lubri- 
cating fluid continuously secreted from the glands of 
the delicate mucous membrane which covers and pro- 
tects them. 



CHAPTER III. 



VARIETIES OF VOICE. 



FOUR chief varieties of voice are recognized in 
vocal music or utterance ; — two in the voice of 
the male, and two in that of the female. These are 
the bass and tenor, and the contralto and soprano re- 
spectively. The peculiarity depends in part upon the 
natural pitch of the voice, and to a much greater 
degree upon its timbre or quality. The bass voice 
descends lower in the scale than the tenor, and its 
strength and beauty are resident in the graver notes ; 
still, some bass singers can ascend as high as the 
tenor, though not with equal richness and delicacy, 
for the peculiar power of the tenor voice resides in 
the higher notes. In like manner, the contralto, 
whose superiority is manifested in the lower notes, 
may ascend as high as the soprano, but without the 
melody of the soprano, whose forte is in the higher 
notes. A baritone voice is a tenor voice possessing 
but a moderate compass in the higher scale, and yet 
incapable of going very low; and a mezzo-soprano 
is a soprano voice in the same relative condition. 
10* H 113 



114 THE THROAT AND THE VOICE. 

There are other varieties of voice named by profes- 
sional vocalists, but they are not of scientific interest, 
and are mere modifications of bass, tenor, contralto, 
and soprano. 

In singing from the same score, the male voice will 
be pitched one octave below the female voice. In 
exceptional instances, however, the female voice can 
be pitched at the compass of the male, and the effect 
is the peculiar tenor-like quality with which we are 
sometimes regaled by these phenomenal vocalists. 

The physical cause of this difference in the tone- 
character of the male and female voice, or of the 
two varieties in either sex, is not understood. Mere 
size of the larynx does not account for it, inasmuch 
as a small male larynx does not furnish the soprano 
or contralto quality, nor a large female larynx pro- 
duce a tenor or bass voice. The voices of young 
boys, before puberty approaches, approximate the 
character of female voices ; and formerly the best 
teachers for the female voice were those males in 
whom the feminine character of voice used to be artifi- 
cially preserved for church purposes by a cruel opera 
tion, now happily abandoned. The difference be- 
tween male and female voice may be in part due to 
differences in quality; in its turn physically due to the 
effect on the form of the sound-waves from the shape 
of the larynx as a resonator, above the vocabbands, 
and the shape of the windpipe and thorax as a reso- 



VARIETIES OF VOICE. 115 

nator below them. The outline of the larynx, in front, 
is rounded in the female, and more pointed or angular 
in the male, as is easily determined by feeling the 
Adam's apple, as it is called, in the neck. The out- 
line of the windpipe, too, is more spherical in the 
female, and more hemispherical in the male (see page 
17). The outline of the chest in respiration, and of 
course during vocalization, is different in the two 
sexes, — the chest of the male expanding to a greater 
extent low down, and that of the female to a greater 
extent higher up. These differences in the shape of 
the tubes and resonators must make their impress 
upon the composite form of the sound-wave (see page 
1 01), and thus modify the quality of the sound. 

Various unaccepted theories have been propounded 
to account physically for the possession of bass or tenor 
voice in the one sex, and of contralto or soprano in 
the other. The difference cannot be attributed to 
the general contour of the larynx, nor to the actual 
or relative size of the vocal bands. All tall individ- 
uals are not bassos and contraltos, nor all short ones 
tenors and sopranos ; and the compass of voice is not 
in absolute correspondence with the actual magnitude 
of the vocal apparatus, nor its relative proportion to 
the stature or figure of the individual. 



CHAPTER IV. 

THE VOCAL ORGAN. 

THE vocal organ is contained in the larynx {Jar- 
unx, top of the windpipe), an irregular prismatic 
or trianguloid funnel-shaped expansion of the air-pas- 
sage, on top of the tubular windpipe (trachea.), and con- 
tinuous with it (Fig. VII.). The angular portion of the 
larynx (Fig, VII., 3) is firm and resistant, and presents 
forward in the central portion of the neck, where it can 
be readily felt beneath the skin, forming the projection 
popularly known as the Adam' s apple. This projection 
forms an acuter angle in the male than in the female. 
The broad portion of the larynx is firm below and 
flexible above, and presents backward ; being more or 
less in contact with the posterior wall of the pharynx 
or entrance into the gullet, except during the passage 
of materials that are being swallowed. The outer 
wall of the prismatic larynx on each side is composed 
of a wing of broad, flat, and irregular-shaped carti- 
lage, the thyroid (thureos, a shield) cartilage, which 
shelters the delicate and movable structures within, 
and protects them from undue external injury. The 

116 



THE VOCAL ORGAN. 



117 






larynx being part of the air-passage, there would be 

constant danger of food falling into it on its way to 

the gullet behind, were it not for a leaf-shaped valve 

of cartilage, the epiglottis _,. _ 7TT . _ fc __. 

' r d Fig. VII. — A Front View 

\epi, upon, and glottis, the of the Exteri or of the Carti- 
mouth -piece of a flute], i ag es of the Female Human 
(Figs. VII. and VIII., 4), Larynx. 
which reaches over the 
top of it from behind the 
base of the tongue ; being . 
attached at its root to the 
inner and upper part of the 
angle of junction formed 
by the two wings of the 
thyroid cartilage. This 
valve becomes pressed 
down over the opening 
into the larynx during the 
act of swallowing, and 
thus closes it hermetically 
for the moment. The lower 
portion of the thyroid car- 
tilage (Fig. VIII., 3), on 
each side, is continued in- 
to a pair of prolongations or processes which grasp 
either side of a stout, ring-shaped cartilage, the base 
of the entire larynx, continuous with the uppermost 
portion of the windpipe. This ring-shaped cartilage, 




. Upper Ring of the Windpipe. 2. 
Cricoid, or Ring-like Cartilage, the 
Base of the Larynx. 3. Thyroid, 
or Shield-like Cartilage. (The fig- 
ure 3 is on the Adam's apple.) 4. 
Epiglottis. M. A Membrane unit- 
ing the Cricoid and the Thyroid 
Cartilages. 



u8 



THE THROAT AND THE VOICE. 



the cricoid {krikos, a ring, and eidos, form] (Figs. VII. 
and VIII., 2), is very broad behind, and quite narrow 

in front, much like a seal- 



Fig. VIII.— Side View of 
the Exterior of the Cartilages 
of the Human Larynx. 




2. Cricoid Cartilage. 



ring, — whence its name. 
The narrow portion in 
front is just below the an- 
gular portion of the thyroid 
cartilage, with which it is 
continuous by the inter- 
position of a membrane 
(Figs. VII. and VIII., M), 
crico - thyroid me m brane, 
which is easily detected 
under the skin, a little 
below the Adam's apple, 
and which is felt to vibrate 
as the voice is sounded. 
The firm and resistant out- 
line of the cricoid cartilage 



1. Windpipe. 

3 . Thyroid Cartilage. 4 . Epi- can easily be felt below this 
glottis, m. Membrane uniting mem brane : and immedi- 

Cricoid and Thyroid Cartilages. 

ately below this again are 
the less resistant rings of the windpipe. The broad, 
posterior portion of the cricoid cartilage is symmetric, 
and on each side of the middle line bears a place of 
support for a small prismatic cartilage, the arytenoid 
[arutaina, a ladle (or beak of a pitcher), and eidos, 
shape] cartilage (Fig. IX., 6), quite movable on the 



THE VOCAL ORGAN. 



II 9 



cricoid cartilage, and carrying a sharp projection or 
process anteriorly, to which the posterior and mov- 
able end of the vocal band (Fig. IX., 5) is attached ; 

the anterior and fixed end _. ___ . __. 

Fig. IX. — Interior View of 

of each vocal band being Right Half of the Human 
in close contact in front, Larynx, 
in the angular groove 
formed by the junction of 
the two wings of the thy- 
roid cartilage, a little be- 
low the point where the 
root of the epiglottis (Fig. 
IX., 4) (see page 117) is 
attached, and a little above 
the upper border of the 
crico - thyroid membrane. 
The two vocal bands are 
the sound - producers, or 
generators of the voice ; 
but they are not cords, as 
their common name, vocal 
cords, would imply to the 
uninstructed. They are narrow bands of firm, fibrous 
material. If we compare the movable arytenoid car- 
tilages, to which the vocal bands are attached posteri- 
orly, to the rings of the handle of a pair of scissors, 
the angle of the thyroid cartilage to the pivot which 
unites the two halves of the pair of scissors, and the 




Upper Ring of the Windpipe. 2. 
2. Cricoid Cartilage. 3. Thyroid 
Cartilage. 4. Epiglottis. 5. Vocal 
Band (Vocal Cord). 6. Arytenoid 
Cartilage. 7. Ventricular Band 
(so-called False Vocal Cord). 



120 THE THROAT AND THE VOICE. 

vocal bands to the shanks of the handle, we shall 
obtain a fairly approximative idea of the relative po- 
sitions of these parts and of the chief, to and fro, 
motions to which the vocal bands are subjected. The 
handles of the scissors being separated, there is a wide 
space between the shanks, which represents the shape 
of the breathing space between the two vocal bands 
during ordinary respiration. The handles of the 
scissors being brought in contact, there remains but 
an elliptic space between the shanks, which represents 
the shape of the space through which the air streams 
during phonation or use of the voice ; the vocal bands 
on each side being set in vibration by the escaping 
current of air, just like the tongues or reeds of the 
accordeon or the mouth-organ, during performances 
on those instruments. 

There is a membranous expansion reaching from 
each side of the lower portion of the epiglottis, in 
front, to the arytenoid cartilage behind on each side 
respectively, and there is a musculo-membranous ex- 
pansion between the two arytenoid cartilages. Thus, 
the epiglottis in front, the two folds of membrane, 
aryteno-epiglotlic folds, at the side, and the two ary- 
tenoid cartilages and their intermediate fold, inter- 
arytenoid fold, behind, form the upper boundary of 
the somewhat triangular-shaped entrance into the in- 
terior of the larynx. These structures are continuous 
below with the cricoid cartilage, itself continuous with 



THE VOCAL ORGAN. 



121 



Larynx, as seen from above. 



the windpipe, a rigid tube always open to the passage 
of air, and dividing and subdividing below into nu- 
merous smaller and smaller „. „ „. « „ „. 

, . , t1 . Fig. X.—Bird's-Eye View 

tubes which eventually reach of the Interior of the Hu man 

to the air-cells of the lungs, 
and through which the latter 
are inflated in inspiration and 
partially emptied in expira- 
tion i for after air once gains 
access to the lungs at birth, 
these organs are never more 
than partially emptied. The 
whole structure is supported 
in position by attachments 
to the base of the tongue, 
the tongue-bone, and the 
side walls of the throat. 

Thus the vocal apparatus 
is a wind and reed apparatus, the wind being forced 
from the lungs along the bronchial tubes into the 
windpipe, where it is condensed to a certain extent 
against the lower surfaces of the approximated pair 
of vocal bands, which it sets into phonal vibration as 
it escapes between their edges. The human vocal 
apparatus differs from every artificial wind and reed 
instrument in several particulars. The pair of lungs 
from which the air is driven to set the vocal bands 
in motion, differs from a pair of bellows not only in 
ii 




2. Cricoid Cartilage. 3. 3. Thyroid 
Cartilage. 4. Epiglottis. 5. 5. 

^Vocal Bands. 6. 6. Arytenoid 
Cartilages. 



122 THE THROAT AND THE VOICE. 

configuration, but in principle. There is no valve to 
permit access of air after air is expelled from the noz- 
zle of the bellows, but the air enters and leaves the 
lungs by the same route ; and the lungs are never 
emptied as the bellows are, for the sides of the chest 
cannot be brought into contact. There is no air- 
chamber or reservoir to provide for a continuous flow 
of air in the human apparatus as in the artificial one. 
The reeds are flexible, elastic, membranous bands, 
with only a single edge, each, exposed to the cur- 
rent of air, and capable of vibrating. 

By placing a little mirror into the back part of the 
open mouth (Fig. XL), while the latter is well illu- 
minated, we are able to see an image of the interior 
of the larynx (Figs. XL and XII.), and observe in great 
part the mechanism of the vocal bands in the acts of 
respiration and of production of voice. In this way 
the register of the voice, as it is termed, can be 
studied optically, and its transition points be noted 
by inspection. The credit of the first successful dem- 
onstration of this kind belongs to Signor Manuel 
Garcia, of London, a teacher of vocal music, who, 
in 1854, devised the plan in the interest of vocal art. 
The manipulation is well known to physicians, who 
frequently employ it for observing the condition of 
the parts in disease. The art is termed laryngoscopy 
[from larynx, and skopio, I view], because chiefly em- 
ployed to inspect the interior of the larynx; but it 



THE VOCAL ORGAX. 



123 




Fig. XI.— Image of Vocal Apparatus as Seen in a Mirror 
Held far Back in the Mouth. 



124 THE THROAT AND THE VOICE. 

reveals the image of other structures likewise, a dis- 
cussion of which is foreign to the scope of this little 
volume. 

^. vrr *r ,«. rx The author is so 

Fig. XII.— Natural Size of Image 

of Vocal Apparatus, Viewed as De- firml y convinced of 

picted in Fig. XI. the importance of a 

knowledge of this art 

to all those who are 

really interested in 

the cultivation of 

the voice, whether 

for public speaking, 

for singing, or for 

conversation, that he 

would suggest that 

i. i. i. Rings of the Windpipe. 2. Cricoid some little effort be 

Cartilage. 3. 3. 3. 3. Thyroid Cartilage. 4. 

4. 4 . Epiglottis. 5. 5. Vocal Bands. 7 . 7 . made by tnem to ac- 

Ventricular Bands. 8.8. Back Part of the quire it. Half an 

Tongue. M. Crico-Thyroid Membrane. -. , A . -. 

hour s practice under 
the guidance of one already familiar with the man- 
ipulation is sufficient to learn it, and the necessary 
outlay for an apparatus need not exceed one dollar. 
It certainly stands to reason, that a teacher of elocu- 
tion or of singing, who can examine a pupil's lar- 
ynx or his own, ought to be able to produce better 
results than he could attain without such skill. A 
good idea of the general plan of the anatomy of the 
vocal apparatus can be obtained by examining the 




THE VOCAL ORGAN. 



125 






larynx and windpipe of one of the lower animals. 
Any butcher will furnish these organs from a sheep 
or a calf at a trifling cost, perhaps merely a " Thank 
you." They differ in color, size, and configuration 
from the vocal organs of the human subject, but are 
sufficiently like it to enable one to recognize the differ- 
ent component structures which have been described. 
Two specimens should be obtained to be studied 
together ; one of them to be cut open lengthwise, in 
the middle line in front, and the other to be divided 
lengthwise, in the middle line behind. 

On examining the image of the larynx in the mir- 
ror, in the manner alluded to, we find that the vocal 



Fig. XIII. — Image of 

the Larynx in Respiration. 
(Compare Fig. VI., p. 88.) 



Fig. XIV. — Image of 
the Larynx in Phonation. 
(Compare Fig. V u , p. 87.) 





3. 3. Thyroid Cartilage. 4. Epi- 
glottis. 5. 5. Vocal Bands. 
7. 7. Ventricular Bands. 



3. 3. Thyroid Cartilage. 4. Epi- 
glottis. 5. 5. Vocal Bands. 
7. 7. Ventricular Bands. 



bands are widely separated during ordinary respira- 
tion (Fig. XIII.), the air passing freely and silently in 
11* 



126 THE THROAT AND THE VOICE. 

and out, there being a little increase in the dimension 
of the passageway during inspiration, and a return 
to the former size and position during expiration. 
When the voice is used, the two vocal bands become 
closely approximated posteriorly (below in the figure), 
with only a very narrow elliptic space between them 
(Fig. XIV.), through which the expiratory current 
of air passes, setting the free edges of the elastic and 
tense bands in vibration. The tones of the chest 
portion of the vocal register (chest register) are 
made by vibrations of the entire width of the vocal 
cords or bands, which, as the notes rise in pitch, 
become more tightly stretched, and somewhat more 
tightly pressed together at their extremities, decreas- 
ing the length of the fissure between them, and thus 
practically shortening the surfaces remaining free to 
vibrate, exhibiting the stretching and shortening 
already described (page 99). The tones of the falsetto 
portion of the register (falsetto register) are produced 
by vibrations of the edges of the bands simply ; the 
mechanism of rise in pitch being the same as for the 
chest tones. The transition from chest to falsetto 
register is at F, or F$ in the first space of the treble 



staff, fe-^- fcg- both in the male and in the female voice. 

The head portion of the register (head register), chiefly 
confined to female voices, is due to a close approxi- 
mation, in actual contact, of the posterior portion of 



THE VOCAL ORG AX. 



127 




the vocal bands (Fig. XV.), leaving only the anterior 

portion free to vibrate ; the mechanism otherwise 

being: similar to that of the _. VTr T 

to Fig. XV.— Image of the 

falsetto register. This pecu- Larynx in the Producticn 

liarity in the production of Q f the so-called Head- 
the head-tones was first de- Tones. 
tected, a number of years ago, 
by Mrs. Emma Seiler, now of 
Philadelphia, while studying 
the mechanism of the voice as 
observed in the living vocal- 
ist, and was determined by her 
to be anatomically due to 
certain little needle-like pro- 
longations of gristle (cartil- 
age), which project into the 
posterior portion of each vo- 
cal band for a considerable distance, and thus ren- 
der their close contact — a virtual "stopping" — 
practicable. The image presented during produc- 
tion of the head-tones had been occasionally de- 
scribed, but its special mechanism was not compre- 
hended until explained by Mrs. Seiler, who had 
examined the vocal organs of dead females for the 
purpose of discovering the cause. As anatomists 
had been in the habit of studying the human larynx 
from the male subject, on account of its larger size, 
this point had escaped their attention ; the nodules 



3. Thyroid Cartilage. 4. Epi- 
glottis. 5. 5. Vocal Bands. 

6. 6. Arytenoid Cartilages. 

7. 7. Ventricular Bands. 



128 THE THROAT AND THE VOICE. 

of cartilage being only rudimentally developed in 
the great majority of males. It is possible, therefore, 
by examining the image of the larynx of an indi- 
vidual, to pronounce as to the practicability of the 
production of head-tones. If the little projections 
in the posterior portion of the vocal bands, due to the 
presence of these processes of cartilage, do not exist, 
the voice can only be injured in useless attempts to 
acquire head-tones. 

Similar nodules, but much smaller in size, exist at 
the anterior attachments of the vocal bands. These 
are usually larger in the larynx of the male than in 
that of the female. 






CHAPTER V. 

VOCAL CULTURE. 

PRACTICALLY, all vocal sound is musical, save 
only the automatic-like tones emitted by the 
speaking deaf-mute {mule no longer, however). Mod- 
ulation of speech is musical intonation ; but the com- 
pass employed is a limited one, and the transitions 
slide from one tone to the next instead of proceed- 
ing by fixed intervals, as in song. The sounds of 
speech are chiefly concrete sounds, and the sounds of 
song are chiefly discrete sounds. The sounds of speech 
are run together, as it were, save such separation as 
is requisite for distinct enunciation. The sounds of 
song are separated from each other, save in the utter- 
ance of the consonants of words. The sounds of 
songs without words are altogether discrete. 

The compass of voice utilized in ordinary speak- 
ing in the United States rarely extends beyond the 
musical interval of a fourth (C — F, half an octave, 
four white keys on the piano), except in localities 
where extremes of modulation are customary ; while 
the compass of the ordinary singing voice may ap- 
proach two octaves. 

I 129 



I3O THE THROAT AND THE VOICE. 

So many theories have been advanced as to the 
proper method of cultivating the voice, and the 
proper period at which its systematic cultivation 
should be commenced, that it is difficult to select 
the good and eschew the evil. Most of these theories 
have been evolved from the inner consciousnesses of 
their advocates, with little knowledge of the vocal 
organs, and often without any at all. The theories 
which carry most weight to my own mind are those ad- 
vocated by Mrs. Seiler, of Philadelphia, in her excellent 
manuals on "The Voice in Singing" and "The Voice 
in Speaking; " for they are based upon accurate ana- 
tomical knowledge of the vocal organs, rare musical 
talent, original investigation, and extensive experi- 
ence in teaching. The remarks to follow will chiefly 
concern the well-being of the voice from a hygienic 
or medical point of view, rather than an artistic one. 

The voices of children are much alike in the two 
sexes, and remain so for a few years, sometimes com- 
prising the entire period of childhood. The vocal 
organ of children is quite small, proportionately to 
the bulk of the body, and the pitch of the voice is 
high. When girls arrive at the age of twelve or 
thirteen, however, and boys at from fourteen to sixteen, 
the vocal organ begins to enlarge rapidly, so that 
within from one to three years it becomes nearly 
double its former size. During this period there is 
what is popularly known as a change of voice, most 



VOCAL CULTURE. I3I 

marked in boys, the pitch of whose voices will fall an 
octave, and much less marked in girls, in whom the 
pitch will fall but one or two notes. At the same 
time the quality or timbre of the voice becomes mod- 
ified, acquiring the mature clang which it retains 
during adult life. During this period there should be 
no systematic cultivation of the voice ; and children at 
school should be excused from participating in elocu- 
tionary or other sustained vocal exercises, without any 
detriment to their standing in their classes. 

There is perhaps no other period of life, except 
the extremes of infancy and old age, at which the 
voice cannot be cultivated with advantage ; it being 
understood that very much more can be accomplished 
with youthful, fresh, and flexible organs than with old, 
misused, and rigid ones. If a child shows marked 
talent for singing, and its parents are desirous that 
the talent should be cultivated, it is not too early to 
begin about the fifth or sixth year of age, — provided 
a competent instructor is employed, who will take care 
of the voice and preserve it, rather than develop it. 
Appropriate exercises and songs for such pupils should 
be limited to the compass of an octave or thereabout, 
and should not be practised for more than twenty 
minutes in the twenty-four hours. This plan of treat- 
ment will preserve the flexibility of the vocal organs 
until such time as they are physically susceptible of 
undergoing the requirements of the higher culture. 



I32 THE THROAT AND THE VOICE. 

Above all, the mistake must not be made that an in- 
ferior instructor will be amply sufficient until the 
child is older or further advanced. Far better intrust 
the little one to its own unaided and spontaneous 
efforts; for the disposition, on the part of well- 
meaning teachers of poor judgment, will tempt 
them to display the immature vocal abilities of the 
child to the immediate gratification of its relatives, 
but to the sure detriment of subsequent culture. 
Another point to be borne in mind by parents is this, 
that it is usually a mistake to intrust a female voice 
to a male instructor, unless that instructor is in the 
habit of utilizing skilled female assistants to develop 
the voices of female pupils. So much is left to imi- 
tation, and even to mimicry, in vocal tuition, that 
a pupil intuitively attempts to imitate the quality or 
timbre of the instructor's tone as closely as possible; 
and thus, under a male teacher, a female voice is insen- 
sibly robbed of some of its peculiar feminine quality. 
This remark is applicable, though to a more limited 
extent, to the cultivation of the speaking voice in 
elocution, as well as to the cultivation of the singing 
voice. Children of either sex may be safely intrusted 
to competent female instructors ; but after the voice 
has changed, boys should be taught by men only. 

Teaching in chorus is not calculated to develop the 
inherent capabilities of exceptionally good voices, 
though useful for other purposes pertaining to disci- 
pline. Defects are less apparent ; and therefore in* 



VOCAL CULTURE. I 33 

correct habits are more likely to become confirmed. 
Class instruction, therefore, should be supplemented 
by a sufficient amount of individual supervision. 

For the full development of the voice and for the 
maintenance of any excellence that may have been 
acquired, systematic exercise is requisite. Control of 
the organs for delicate effects is soon lost, if practice 
is long intermitted, just the same as it is with the 
fingers of the skilled instrumental performer. Said 
Wilhelmj once, "If I neglect to practise for one day, 
I notice it ; if for two days, my friends notice it; and 
if for three, the public notice it." This explains the 
reason why those who use their voices in public at 
infrequent intervals are less successful in their results, 
and more amenable to injury from over-effort, than 
those who are accustomed to frequent appearances. 
The actor who treads the stage nightly has a great 
advantage in this respect over the clergyman who 
enters the pulpit but one day in the week. The cler- 
gyman should practise daily for a few minutes in his 
study, and then he will become less susceptible to the 
special form of sore throat associated with intermit- 
tent labors, and to which histrionic vocalists, as a 
rule, are not subject. For a similar reason, the ama- 
teur elocutionist or vocalist who would attain excel- 
lence and maintain it, should keep up a moderate 
amount of systematic practice in the privacy of his 
own apartments. 



CHAPTER VI. 

IMPROPER USE OF THE VOICE. 

IMPROPER methods of using the voice lead to cer- 
tain affections of the throat, the chief one of which 
is popularly known as clergyman' s sore throat, though 
by no means confined to members of the clerical 
profession. It occurs in all classes of persons who 
strain the voice or misuse it. It consists in a conges- 
tion of the mucous membrane and muscles of the 
throat, with enlargements of many of the minute glands 
which secrete the lubricating fluid that keeps the sur- 
face of the throat moist and pliable. These enlarged 
glands are visible in the form of prominent groups 
of projections, varying from the bulk of pin-heads to 
that of small peas or beans, irregularly distributed 
upon the surface of the mucous membrane. The 
mouths by which these glands discharge their lubri- 
cating material being choked up by swelling, that 
material becomes pent up in them and unable to es- 
cape, and thus accumulates in the glands and distends 
them. Now the congestion above alluded to, which 
is the first step in the entire process, is produced in 

134 



IMPROPER USE OF THE VOICE. 1 35 

the following manner: — The muscles of the throat, 
which should be more or less at rest during the use of 
the voice, are absolutely put into continuous con- 
strained action in improper methods of speaking, as 
is evinced by uncomfortable sensations during pro- 
tracted or impassioned speaking, or shortly after it. 
In the same manner as physical consciousness of the 
possession of a stomach, or of a tooth, or of a toe, 
for example, is evidence that something is wrong for 
the time with the stomach, the tooth, or the toe, so 
physical consciousness of the possession of a throat 
during speaking, or shortly afterward, is evidence 
that something is wrong with the throat. The strain 
upon the muscles, and the sense of uneasiness follow- 
ing, are cause and effect; both of which may be 
avoided by proper use of the organs of voice and of 
speech. In civilized communities, conventional or 
affected methods of doing things of various kinds 
are employed by many people instead of natural 
methods, for various reasons, such as the desire to 
impress others with a sense of individual importance 
or originality ; and these methods are copied or imi- 
tated by others. Hence erroneous and affected methods 
of speaking become widespread. 

To appreciate this point in the subject before us, 
it will be advisable to consider the factors of natural 
voice and speech ; and then the injurious effects of 
departures from it can be properly estimated. 



I3 6 



THE THROAT AND THE VOICE. 



The first point to consider is that of respiration. 
This important function must not 
be interfered with during speech, 
and should be so managed as to be 
performed naturally or without con- 
scious effort. It is painful to see 
the labored phases of inspiration, or 
taking breath, which are exhibited 
by many female vocalists, whose 
manner of dress makes it more con- 
spicuous ; . and still more painful to 
witness it in a preacher, whose dress 
and surplice, even, do not hide it 
from the observation of his audit- 
ors. 

It is well known that the thorax 
or chest expands somewhat in in- 
spiration, or taking breath in, and 
contracts again in expiration, or 
a photograph.) The giving breath out. Now a little 
dotted transverse observation will show that in ordi- 
lines represent the na ry tranquil inspiration the soft 
positions of the dia- parts below the chest become bulg- 
phragm; the heavier ed forward ^ in CO nsequence of the 




Fig. XVI. — Ab- 
dominal, Diaphrag- 
matic, or Natural 
Type of Respiration . 

(The figure has 
been reduced from 



one, its position after 



descent of the diaphragm, a soft 



expiration; the lighter 

one, in inspiration, partition between the chest and the 

abdomen. In addition to this, the 

ribs at the lower portion of the chest expand slightly, 



IMPROPER USE OF THE VOICE. 



137 



but the upper ribs remain practically undisturbed. 
This is what is termed the abdominal or diaphrag- 
matic type of respiration (Fig. XVI.), because the ab- 
domen and the diaphragm are the 
principal factors of the process. 
As the abdomen expands, the dia- 
phragm becomes depressed, increas- 
ing the capacity of the chest verti- 
cally, and the air passes readily in- 
to the expanded lungs. In females, 
the ribs participate more freely in 
the expansion of the chest than in 
men, the upper ribs particularly. 
If a deep inspiration is favored by a 
voluntary continuance of the action 
of the abdomen and diaphragm, it 
is found that the action of the ribs vicular Type of Res- 
becomes augmented, and that the piration, succeeding 
entire series of ribs enters into the Abdominal and Cos - 
movement progressively from be- tal Types in Succes- 

low upwards, still further increas- sion ' A forced and 

, r , . , unnatural type, 

ing the capacity of the chest, and 

thus drawing a larger amount of air into it. This is 
what is termed the lateral, costal, or rib type of respi- 
ration. If a still further effort be made to draw air 
into the chest, or fill the lungs to their utmost capac- 
ity, the collar-bones rise after the ribs have all become 
expanded, and the upper portion of the breastbone 
12* 




Fig. XVII.— Cla- 



138 



THE THROAT AND THE VOICE. 



rises. (Fig. XVII.) This is the clavicular or collar- 
bone type of respiration. Indeed, if the effort is 
pushed to its uttermost, then the 
bones of the spinal column, and, as 
a matter of course, the skull on top 
of it, rise also, so as to increase 
the capacity of the chest to its ex- 
treme limit, while at the same time 
the abdominal wall sinks inward 
towards the spinal column. If the 
inspiration begins with the eleva- 
tion of the clavicle, and the dis- 
tention of the upper ribs, the re- 
traction of the abdomen is quite 
marked. The contrast between 
the outlines of deep abdominal res- 
piration and deep clavicular respi- 
omina an o eep rat ' on j n ^ e ma j e subject, is well 
Clavicular Respira- 

tion contrasted." *own ™ Fig. XVIII. The forced 
(The heavy dotted abdominal inspiration can be main- 
outline exhibits the tained for the requisite number of 
abdominal type, and seconds, with comparatively little 
the light dotted out- effort, and utilizes the entire volume 
line the clavicular c . . ., •, , 

of air in the lungs, upon vocal 

organs in a natural position ; while 
the forced clavicular type requires considerable effort 
for its maintenance, and utilizes only the upper por- 
tion of the volume of air upon vocal organs in a con- 




Fig. XVIII.— Dia- 
gram of deep Ab. 



IMPROPER USE OF THE VOICE. 1 39 

strained position. The best efforts of elocution and 
singing are produced from a full chest of air inspired 
according to the natural or abdominal type. 

Now, the trouble with many public speakers and 
singers is that, under a mistaken conviction that it is 
important to fill the lungs as much as possible at the 
commencement of a sentence or phrase, they habitu- 
ally adopt the clavicular type of respiration instead of 
the abdominal type, which is the natural one for ordi- 
nary use, to be supplemented by the costal and cla- 
vicular types only under rare occasions for momentary 
use in the production of certain effects, or under the 
influence of certain emotions. The consequence of 
this vicious mode of respiration is that, by a powerful 
muscular effort of the auxiliary muscles of respiration, 
the thorax becomes fixed in a constrained position, 
and likewise the organ of the voice itself; and the 
muscles of the throat, which should be in a relaxed 
condition, become more or less fixed also ; so that 
additional muscular effort is requisite to produce the 
necessary vocal sounds. This is not only fatiguing 
to the individual, but it produces a constrained voice, 
disagreeable to the ear of a cultivated hearer ; while 
the effort necessary to keep speaking, diverts the 
powers of the speaker from gliding into many natural 
embellishments germane to the occasion or to the 
subject. 

Another effect of taking too deep and strained an 



140 THE THROAT AND THE VOICE. 

inspiration, is that some of the breath is often given 
out again before the voice is produced, and thus abso- 
lutely rendered ineffective. The voice is produced 
only during an expiration, and every particle of ex- 
pired air should be utilized, in order to accomplish 
the best effect with least effort. But if a strained 
inspiration has been made, there is either a painful 
stop before speaking, or else some of the air is allowed 
to escape, to relieve the uncomfortable sensation in 
the chest, before the vocal muscles can be brought 
into proper position. In this manner, the whole of 
the air painfully inspired is not used after all. The 
escape of air without utilization in voice renders fre- 
quent inspirations necessary, and thus the pernicious 
process is repeated. 

In addition to this, the constrained position of the 
vocal organs prevents due play of the muscles of the 
vocal bands, alters their physical relation to the im- 
pact of the escaping currents of expired air, and thus 
enfeebles the natural tone of the voice, and renders 
it less sonorous and less susceptible of modulations. 
In consequence of this, the sounds are proportionately 
weak, shrill, and monotonous. In taking breath, then, 
during exercise of the voice, the habit should be culti- 
vated of breathing by the abdominal method instead 
of elevating the upper ribs, collar-bone, and breast- 
bone. This supplemental method will follow the 
other naturally, and without visible effort, when re- 



IMPROPER USE OF THE VOICE. 141 

quired in the emotion of a special and appropriate 
occasion. 

In public speaking and in singing it is requisite 
that a supply of breath be taken in, rather quickly, 
at certain intervals, determined either by the charac- 
ter of the passage, or the nature of the effect to be 
executed ; and that this supply be husbanded by con- 
trolling the expiration in such a manner that the 
breath shall be allowed to escape from the chest as 
slowly as is compatible with efficient utterance. In- 
spirations, therefore, have to be taken at irregular 
intervals, varying with the sense of the passage, phrase, 
or sentence \ and consequently no special rules can be 
given, applicable to all occasions. All attempts to 
formulate such rules have been failures. It is proper, 
however, to take an inspiration quietly, at every con- 
venient pause in utterance, and to utilize every por- 
tion of the expiration following, in the production 
of sound. The voice should begin at the very instant 
of expiration, — at the very moment of impact of the 
air against the vocal bands \ but the expiration should 
not be prolonged unnecessarily, for that will deprive 
the sounds of due volume and fulness towards the 
close of the expiratory effort. Care should be exer- 
cised not to take breath too often. This produces a 
disagreeable effect. Practice is the only criterion in 
this respect, and, to be most effective, the practice 



142 THE THROAT AND THE VOICE. 

should be at first under the supervision of a compe- 
tent critic or instructor. 

In order that respiration be properly performed 
during vocal exercise, it is essential that there should 
be no constriction at the waist. The waistcoat of 
the male and the corsage of the female should be 
sufficiently loose to permit of free abdominal res- 
piration. Close fitting or tight corsets, therefore, 
interfere mechanically with efficient respiration, and 
impair the vocal powers accordingly. 

An easy position of the body should be assumed 
during public use of the voice or during vocal prac- 
tice. The erect position is the best, with the book, 
manuscript, or score at an easy reading distance, at 
about the level of the neck or chin, so that the head 
need not be depressed, and thus interfere with easy 
utterance and intonation. The body must not be 
turned too much to the right or left of the middle 
line, as that prevents distinct hearing by the audience 
at the opposite side of the room. There is hardly 
any public hall which permits equal facility of hear- 
ing in every part of it. It is proper, therefore, to ad- 
dress the central portion of the audience ; by which 
plan those at the two sides are placed under equal 
advantages. Addresses first to one side of the room 
and then to the other deprive those at each side, suc- 
cessively, of the remarks which are being made to 
the people at the opposite side of the house. 



CHAPTER VII. 

VOCAL GYMNASTICS. 

THE value of systematic gymnastic exercises, in de- 
veloping the capacity of the muscles in general, 
is universally conceded. There are a number of ex- 
ercises of this kind which develop the flexibility and 
control of the muscles which are employed in the pro- 
duction and use of the voice. These are the muscles 
of the diaphragm, of the chest, of the larynx, of the 
pharynx, palate, tongue, mouth, and jaw. The gain 
to the individual in prosecuting appropriate exercises 
of these muscles is being appreciated by instructors 
in elocution and in singing; and certain forms of 
exercises have been adopted with success by some 
professional cultivators of the voice. The methods 
employed vary with different teachers. 

The muscles of the diaphragm may be exercised by 
forcible distention or expansion of the abdomen, fol- 
lowed by a quick recession of its walls, as if shrinking 
from a threatened blow. These movements are repeated 
a number of times, with varying degrees of force, ex- 
tent, and rapidity, until they begin to become uncom- 

H3 



144 THE THROAT AND THE VOICE. 

fortable, when they should cease for the time. They 
may accompany the phases of the respiratory act, the 
walls of the abdomen advancing during inspiration 
and retreating during expiration, and may be per- 
formed partly with the mouth closed and partly with 
the mouth moderately or widely opened. 

The muscles of the chest may be exercised in a 
variety of modes. Jumping the rope back-door, as 
it is called, is a very good method of developing the 
large muscles of the upper portion of the front of 
the chest. Men often prefer the use of dumb bells 
or Indian clubs. Movements of the arms forward 
and backward, as if pushing something forward and 
then pulling it backward, likewise develop these and 
other muscles. Movements of the trunk of the body 
forward, backward, and to either side, the motion 
taking place at the hips, develop the lower muscles 
of the chest and those of the abdomen. Walking, 
swimming, and rowing likewise develop the muscles 
of the chest. Deep inspirations through the nostrils, 
or through a tube of some kind held in the mouth, 
develop certain intrinsic muscles of the chest which 
extend from each set of ribs to the adjoining ones. 

The muscles of the larynx are best exercised by 
systematic singing exercises on the tones at and near 
the middle of the ordinary compass of the individual. 
Repetitions of the first portion of the act of swallow- 
ing, the mouth being closed, exercise the muscles of 



VOCAL GYMNASTICS. I45 

the pharynx, palate, base of the tongue, and some of 
the muscles of the larynx, which can be felt to ascend 
and descend during the movements. Forcible expi- 
ratory efforts with the lips firmly closed, so as to pre- 
vent any escape of air, strengthen the muscles of the 
pharynx and upper part of the front of the neck. 

The muscles of the tongue are exercised by pro- 
truding and withdrawing it, by turning the tip up to 
the roof of the mouth and down to the floor of the 
mouth, and by turning it to either side of the mouth. 

The muscles of the mouth are exercised by system- 
atic movements of the lips. 

The muscles of the lower jaw are exercised by 
moving it forward and backward. 

Flexibility of the voice is best practised, according 
to Mrs. Seiler, by simple exercises on the syllable koo^ 
at intervals of tones and semitones., and with gradu- 
ally increasing quickness. 

A good deal has been written about the position 
which should be given to the escaping current of air 
during vocalization, so as to vary the effect according 
as the column strikes different portions of the mouth, 
throat, and nasal passages. Views vary a great deal 
with different instructors, and I know of no general 
rules applicable to all individuals. Exercises are best 
instituted under the guidance of the singing or elocu- 
tion teacher, to correct defects of utterance as pre- 
sented by individual pupils. The chief fault is that 
13 K 



I46 THE THROAT AND THE VOICE, 

the waves of sound are directed too much towards the 
back part of the throat, instead of towards the front 
of the mouth. The peculiar attractive tones of the 
Italians are due to their custom of directing the waves 
of sound towards the lips. The guttural character 
of the tones of most English-speaking people is due 
to their habit of directing the sound-waves too much 
towards the back part of the throat. When the sound- 
waves issue from the mouth, as it were, their shape or 
form is more regular than when they issue more from 
the throat ; and, as we have seen (p. 101 ), the timbre 
or quality of sound is due to the shape or form of the 
sound-wave. 



CHAPTER VIII. 

DEFECTS OF VOICE. 

A GREAT defect in vocal utterance, the organs 
being healthy, is due to pitching the voice in too 
high a key, that is to say, in too high a portion of the 
vocal register. Prolonged efforts at public speaking 
in too high a key are fatiguing, painful, and injurious 
to the voice. The fault may be corrected by paying 
particular attention to one's utterance for a time, even 
in ordinary conversation, until the proper method 
gradually becomes habitual, so as not to require at- 
tention any longer. The so-called chest portion of 
the register is the proper one to use, especially for 
men ; but care must be taken not to use the very 
lowest portion of the register, as that would develop 
a defect in the opposite direction. When we speak 
in such tones that the chest is felt to vibrate under 
the impact of the sound-waves, we are using the voice 
in the most efficient and agreeable manner ; and if 
we endeavor to imitate the tones of the voice of a 
friend whose utterance is particularly agreeable to the 
ear, it will be evident, by our sensations, that the 

i47 



I48 THE THROAT AND THE VOICE. 

vibrations of the sound-waves are being transmitted to 
the walls of the chest. A person in fairly good health 
can speak for hours, when necessary, in this portion 
of the register, without becoming over-fatigued. If 
unaccustomed to using the abdominal type of respira- 
tion, it is essential that the habit of doing so be ac- 
quired. The most effective and pleasant character 
of voice is produced with the use of the abdominal 
type of respiration and the chest portion of the 
register. 

Speaking too loud is another common fault of 
public speakers. It is often practised to overcome 
the defect produced by speaking in too high a key. 
The reach of the voice being less in the higher key, 
forcible efforts are made to throw the sound of the 
voice forward, as it were, so as to reach the auditors 
at the greatest distance from the speaker. The effect is 
disagreeable to the listener; and the effort is injurious 
to the voice, and exhausting to the speaker. If the 
respiration and the key-note are well managed, the 
voice will reach the furthest limits of the largest 
hall without any violent effort. A natural tone, such 
as is employed in thanking a friend for an ordinary 
courtesy, is the best one even for speaking from the 
platform or reading-desk. Indeed, it is related of 
one famous actor, that when going on the stage he 
would ask some bystander the time of day, and, on 
learning it, would reply " Thank you " in an ordinary 



DEFECTS OF VOICE. 1 49 

tone, which he preserved as his key-note in com- 
mencing his address. It is only on certain occasions, 
when it is necessary to overpower other noises, as when 
many are speaking at once, that a public speaker is 
compelled to raise his voice to command attention. 
Otherwise, a voice but little louder than the tone em- 
ployed in general conversation will suffice to fill a 
large lecture-room or other auditorium. 

Speaking too rapidly is another defect in the use 
of the voice, which mars its efficacy. Very few public 
speakers are deliberate enough in their utterances. 
Rapid speech interferes with the elementary princi- 
ples of acoustics. In the first place, sound-waves 
require a certain length of time to travel from one 
end of a room to the other. Then they undergo re- 
flection from the walls of the room and converge 
towards the centre of the apartment, where they be- 
come irregularly commingled with the direct waves, 
and thus create a confusion of sounds which does not 
subside on the instant that utterance ceases, but con- 
tinues an appreciable period afterward. Due allow- 
ance must in all instances be made for the resonance 
of the apartment, and time be given for its subsidence. 
If a series of sound-waves are generated from the 
mouth of a public speaker in too rapid a succession, 
each successive wave or impulse is liable to strike 
against the rebound of those which have immedi- 
ately preceded it, and thus to impair their precision 



I50 THE THROAT AND THE VOICE. 

of oscillation, mechanically dampening the sound. 
Thus, only a more or less confused succession of vocal 
sounds are appreciable by the audience; a jumble 
from which, it is true, the impressions emanating 
from the speaker may be gathered, but only at the 
expense of a certain amount of disagreeable effort of 
attention. Each tone is not heard forcibly and dis- 
tinctly. The minds of the auditors are diverted from 
imbibing the subject-matter of the discourse by very 
reason of the mental strain necessary to follow the 
jumbled and mumbled utterances of the speaker ; 
and therefore the discourse itself fails to make that 
favorable impression it might be entitled to produce, 
if those who listened to it had an opportunity to con- 
centrate their attention upon the theme. Slowness 
of utterance, free from drawl, and with well-balanced 
pauses, sufficiently long to await subsidence of the 
confused mingling of direct and reflective sound- 
waves, is essential to excellence in public use of the 
voice. 

As well put by an astute critic,* " The great diffi- 
culty in elocution is to be slow, and not to seem 
slow ; to speak the phrases with such distinctness, and 
such management of the breath, that each shall tell, 
yet due proportion be maintained. . . . The art is so 
to manage the time that it shall not appear slow to the 

* George Henry Lewes. 



DEFECTS OF VOICE. I 5 I 

hearer. ... No sooner have they (actors) to express 
excitement or emotion of any kind, than they seem to 
lose all mastery over the rhythm and cadence of their 
speech. Let them study great speakers, and they will 
find that in passages which seem rapid, there is a 
measured rhythm ; and that even in the whirlwind of 
passion there is as strict a regard to tempo as in pas- 
sionate music. Resistent flexibility is the perfection 
of elocution." 

Speaking through too contracted an opening in the 
mouth interferes mechanically with due play of the 
waves of sound, and renders utterance indistinct at 
any distance. 

A bad habit with many speakers, consists in giving 
too much time to the consonants of speech, and too 
little to the vowels. The consonant sounds are, vir- 
tually, noises produced by certain motions of the con- 
stituent parts of the mouth, as the lips, teeth, tongue, 
and palate, which break the voice up into articulate 
speech. The chief vocal sounds are those of the 
vowels. The vowels may be compared to the sounds 
from the strings of the violin, the consonants to 
the noises produced by the movements of the bow. 
If the noises of the consonant sounds are too pro- 
nounced, and the music of the vowel sounds slurred, 
enunciation becomes proportionately indistinct. The 
consonants should just be touched, as it were, and the 
volume of sound be permitted to dwell upon the 



152 THE THROAT AND THE VOICE, 

vowels. Indeed, at great distances, it is from the 
succession of vowel sounds that the sense of a word 
or phrase is gathered, the consonant sounds being too 
weak to be carried as far.* Care is requisite, therefore, 
to give due time to each vowel sound, avoiding pro- 
longation of the sound into a drawling or sing-song 
style, which is disagreeable and ludicrous. 

Another defect of voice is produced chiefly by an 
affected class of clergymen, who are anxious to im- 
press their hearers with an excessive amount of solem- 
nity of utterance in certain forms of admonition. 
The effect is somewhat similar to that which may be 
produced by speaking through the slightly closed fist 
held in front of the mouth. It is a reverberation of 
the voice produced by drawing the epiglottis down 
from its erect position, so that it stands obliquely 
over the top of the larynx, and thus catches the waves 
of sound and deflects them to the back portion of the 
throat. It is sometimes heard upon the stage in un- 
trained actors who take the parts of the villains in 
certain melo-dramas and tragedies ; and is not infre- 
quent upon the platform. Excessive use of this 
method of utterance sometimes alters the position 

* Among the slaves of the cotton -fields, it used to be common 
for parents to give their children such names as Tom, Bob, Pete, 
and the like, so that they could hear their mammies call them at 
a great distance ; a utilization of vowel sounds by the untutored 
negro, from which cultured whites may well learn a lesson. 



DEFECTS OF VOICE. 1 53 

of the epiglottis permanently, and renders the defect 
very difficult to remedy. 

A peculiar defect of voice sometimes encountered 
in men is a shrill, infantile, falsetto tone, or one 
somewhat like the treble of childhood, as if the usual 
change of voice had not taken place at puberty. As 
this is the sort of voice described as common to 
eunuchs, in whom the change is artificially prevented, 
the term eunichoid voice has been employed to des- 
ignate it. 

It is almost always a mere matter of habit. The 
individual is usually able, by an effort, to use his 
voice in the lower key, but he is impressed with the 
idea that this voice is unnatural. It sounds to him- 
self so much deeper, by contrast, than what his voice 
really should be, that a great deal of persuasion is re- 
quired to induce him to abandon the use of his false 
key, and adopt the natural one. The fault is best 
overcome by careful practice, in the lower key, under 
the supervision of a teacher of elocution, with im- 
mediate abandonment of the usual tone of voice, even 
if it be necessary for the time to resort to a whisper 
for ordinary purposes of conversation. Strangers will 
not notice anything amiss with the newly-acquired 
key of the voice, though it may appear unnatural for 
a considerable time to the individual and his imme- 
diate associates. 



CHAPTER IX 

CARE OF THE VOICE. 

A PROPER method of producing vocal sound 
having been secured, it is important that proper 
care be taken of the voice. 

It should not be fatigued by too long exercise at 
any one time, and the limits of salutary exercise vary 
in individual cases, just as with muscular exercise in 
general. As soon as the parts begin to feel dry and 
uncomfortable, and a sense of effort is felt necessary 
to produce the results which up to that time followed 
without consciousness of special effort, that moment, 
or as soon after it as at all practicable, the use of the 
voice should be suspended. The vocal effort should 
not be made during fatigue or hunger. Rest is req- 
uisite in the one instance, and a slight repast in the 
other. The voice should not be exercised, either, 
after a hearty meal, for a full stomach interferes with 
the free play of the diaphragm, and consequently 
with normal abdominal respiration. In addition to 
this, as the pharynx is part and parcel of the aliment- 
ary apparatus, it participates in the increased circula- 

'54 



CARE OF THE VOICE. 155 

tion through that apparatus during active digestion, 
and is thus impaired for the time as a perfect resonator 
or reinforcer of the voice. 

If the throat becomes dry during the use of the 
voice, it may be moistened at convenient intervals 
by taking a sip of water, which should be held in the 
mouth a moment or two before it is swallowed. Deep 
draughts of water flood the stomach too much, 
and afford no greater relief to the parching throat. 
With proper voice production, the sip of water is 
never necessary. The habit of resorting to it should 
be broken up as speedily as practicable. Ice may be 
held in the mouth during the intervals of repose be- 
tween performances, if more agreeable than water, 
as it often is. The use of lozenges is rarely of ad- 
vantage for these purposes, and those lozenges com- 
posed of pure gum or gelatine are the most efficacious. 
A good article of jujube paste, plain or acidulated, 
may be used. Medicated lozenges are apt to be 
detrimental, unless properly selected for some special 
influence that may be desirable at the time. 

The voice should not be used for public purposes 
during ever so mild an attack of sore throat, or any 
indisposition that makes its use require unusual effort. 



INDEX. 



PAGE 

Abscess, of pharynx, 14; of ton- 
sil 36 

Acoustics of voice 89 

Air-passages, 11; air-tract, 10; 

air-tube 10, 11 

Alcoholic beverages 25 

Alimentary tract, the 10, 11 

Artificial openings in windpipe 76 
(See Tracheotomy.) 

Arytenoid cartilages 118 

Atmospheric influences 10 

Baritone voice 113 

Bass voice 113 

Bathing 25 

Boots 28 

Breath, management of, in public 

use of voice 141 

Bronchial tubes 11 

Care of the voice 154 

Catarrh, naso-pharyngeal 83 

Catarrhal chronic sore throat, 

66; laryngitis 69 

Causes of croup, 50; of sore 

throat 22, 23, 30, 68 

Change of voice 130 

Chest-register 126 

Cilia of mucous membranes 18 

Clang 104 

14 



PAGE 

Cleansing nasal passages, etc 35 

Clergyman's or clerical sore 

throat 58, 134 

Compass of voice 98, 105, 127 

Consonant sounds 151 

Consumption, laryngitis of,.... 69, 70 

Contralto voice 113 

Correlation of forces 92 

Cough, 12; ear, 81; spasmodic. 79 

Cricoid cartilage 117 

Crico-thyroid membrane 118 

Croup 49, 74 

Cultivation of the voice 130 



Defects of voice 147 

Difference-tones 102 

Diphtheria . 42, 75 

Dropsy of the larynx 54 



Ear, diseases of. 15 

Ear cough 81 

Enlarged tonsils 66, 107 

Epiglottis 12, 15, 117, 152 



False teeth 72, 107 

Falsetto-register, 126; voice 153 

Flexibility of voice 145 

Folliculous sore throat 58 

Food-pipe. (See (Esophagus.) 

157 



i 5 8 



INDEX. 



PAGE 

Foreign bodies 52, 72 

Fundamental tones 101 

Furniture, in tones of organ-pipes 103 



Gargles 37 

Ground-tones 101, 104 

Gullet. (See CEsophagus.) 
Gymnastics, vocal 143 



Harmonic tones 102, 103 

Head-register, 126; image of lar- 
ynx in 127 

Hearing, impairment of. 63 



Ice, use of. 155 

Ice-water 24 

Image of interior of vocal appa- 
ratus 123, 124, 125 

Improper use of voice 134 

Inhalations 45, 51 

Intensity of sound 96, 97 



Laryngitis, acute, 53; ca- 
tarrhal, 69 ; chronic, 68 ; in 

consumption 69 

Laryngoscopy 55 

Larynx 10, 16, 116 

Lime, use of fumes of. 46, 51 

Lozenges 57, 58, 155 



Measles 33, 40, 74 

Membranous croup 49 

Mezzo-soprano voice 49 

Motion, sound a form of. 90 

Music, physical characters of..... 94 



page 

Nasal passages n 

Naso-pharyngeal catarrh 83 

Neuralgia 82 

Noise, physical characters of. 94 



CEsophagus 11, 14 

Organ-pipes, tones of. 103 

Over-tones 102 



Palate, hard, 12 ; soft 12 

Paralysis 44, 75 

Pharynx 10, 12, 14 

Phonation, image of interior of 

larynx in 125 

Pitch of sound 93, 96, 98, 109 



Quality of sound 96, 100; phys- 
ical cause of. 101 

Quinsy 13, 35, 107 



Reach of voice 106 

Reflex action 32 

Respiration, abdominal type of, 
136 ; clavicular type of, 138 ; 
costal type of, 137 ; image of 
interior of larynx in, 125 ; man- 
agement of in vocal utterance, 

141; natural 11 

Respirators 19, 20, 21, 29 

Respiratory tract, the 10 



Scalds 3 1 

Scarlet-fever, 33, 40 

Shoes, proper use of, etc 28 

Small-pox 33, 4° 



INDEX. 



159 



PAGE 

Smokers, milky patches of. 24 

Smoking 23 

Song, sounds of. 129 

Soprano voice 113 

Sore throat, acute, 30 ; causes of, 

22 ; chronic, 56 ; common, 33 ; 

membranous, 38 ; rheumatic... 34 

Sound 89 

Spasm 79 

Spasmodic croup, 79, 88 ; cough.. 79 

Speech, sounds of. 129 

Sprays 37 

Steam, inhalations of. 45, 51 

Stridor 78, 88 

Summation-tones 102 



Teeth, influence of loss of, on 
voice 107 

Throat, care of, 19 ; general con- 
struction of, 9 ; consumption 
of. 69-71 

Thyroid cartilage 116, 117 

Timbre. (See Quality.) 

Tones, fundamental and acces- 
sory 101, 102 

Tonsils 13, 66, 107, 108 



PAGE 

Trachea 10, 16 

Tracheotomy 47,52, 73 

Trades, effects of various 56 

Tumors in the throat and wind- 
Pipe 74 



Ulcers 18 

Underclothing 26 

Upper-tones 102 

Uvula 12, 64,108 



Vocal apparatus, 112; bands, 76, 
87, 88, 98, 119 ; cords (see 
bands) ; culture, 129 ; gymnas- 
tics, 143 ; organ 116 

Voice, 87 ; acoustics of, 89 ; care 
of the, 154; change of, 130; 
compass of, 98; defects of, 147; 
improper use of the, 24, 134; 
varieties of. 113 

Vowel sounds no, 152 



Windpipe. (See Trachea.) 



The End. 



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